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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000931
Report Date: 10/09/2024
Date Signed: 10/09/2024 02:36:05 PM


Document Has Been Signed on 10/09/2024 02:36 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:CANDLELIGHT HOME CAREFACILITY NUMBER:
347000931
ADMINISTRATOR:DOBRE, EMILFACILITY TYPE:
740
ADDRESS:7224 CANDLELIGHT WAYTELEPHONE:
(916) 725-5680
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:6CENSUS: 5DATE:
10/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Administrator Emil DobreTIME COMPLETED:
02:40 PM
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On 10/09/24, Licensing Program Analysts (LPAs) Cheyenne Ratajczak and Graham Gunby arrived unannounced at the facility to conduct a Required 1- year annual inspection utilizing the care tool. LPAs met with Administrator Emil Dobre and explained the purpose of the visit.

LPAs and Administrator conducted a tour of the interior and exterior of the facility. Areas toured include but not limited to: four (4) private and one (1) shared resident room, four (4) bathrooms, kitchen, laundry room, backyard, storage area, and the common areas. LPAs observed two (2) residents in the common area watching television and three (3) residents in their rooms. LPAs observed the facility to have two (2) days of perishable and seven (7) days of nonperishable foods. LPAs observed that sharps, toxins and medications are locked. Fire extinguisher was last serviced on 09/13/24.

LPAs conducted a file review of two (2) personnel and three (3) residents records. LPAs also conducted a medication check for two (2) residents.

LPAs completed the full care tool and no deficiencies was observed.

Exit interview conducted and a copy of the report was left at the facility.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Cheyenne RatajczakTELEPHONE: (916) 969-7879
LICENSING EVALUATOR SIGNATURE:
DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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