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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001619
Report Date: 11/03/2021
Date Signed: 11/03/2021 12:04:07 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:GLEN CREEK VILLA II-RES. CARE FAC. FOR THE ELDERLYFACILITY NUMBER:
347001619
ADMINISTRATOR:OSANU, NICOLETAFACILITY TYPE:
740
ADDRESS:8510 ELM AVENUETELEPHONE:
(916) 988-8285
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:6CENSUS: 5DATE:
11/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:33 AM
MET WITH:Licensee and Administrator- Florinel Osanu and Nicoleta OsanuTIME COMPLETED:
12:07 PM
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Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced on 11/03/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Licensee and Administrator, Florinel Osanu and Nicoleta Osanu, and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and contacted licensee and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA were screened by facility staff upon entering the facility.

LPA toured the interior and exterior of the facility together with Licensee and Administrator to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, five (5) resident bedrooms, two (2) bathrooms, kitchen, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA, Licensee, and Administrator completed the infection control domain and facility was found to be in substantial compliance at this time.

LPA requested for Licensee to submit documents to Community Care Licensing by 11/10/2021.
  • Liability Insurance
  • Fire Clearance

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report left at the facility.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
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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