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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347002482
Report Date: 12/09/2022
Date Signed: 12/09/2022 12:31:30 PM


Document Has Been Signed on 12/09/2022 12:31 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:IN LOVING HANDS CARE HOMEFACILITY NUMBER:
347002482
ADMINISTRATOR:SFERDIAN, STEVEFACILITY TYPE:
740
ADDRESS:7709 CHIPMUNK WAYTELEPHONE:
(916) 723-8110
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 5DATE:
12/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Adina Sbingu, Co-Administrator TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met Maria Radu, caregiver, who contacted Adina Sbingu, Co-Administrator by phone. LPA met with Adina Sbungu, Co-Administrator and explained purpose of inspection. LPA observed (1) resident in the common area and (4) residents in their rooms at the start of the inspection. During the inspection, at approximately 11:30 am, resident (R1) experienced a change in condition and 9-1-1 was contacted to assess resident. Resident was taken out of the facility by the paramedics for further medical evaluation at approximately 11:45 am. Co-Administrator to submit LIC624 to the department within 7 days. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (3). Currently, there is (1) resident on hospice. Prior to initiating today's inspection, LPA completed required COVID-19 Department protocols, wore a surgical mask and was screened per Covid-19 precautionary measures upon entering the facility.

LPA and the Co-Administrator toured the interior and exterior of the facility including the common areas, (4) resident bedrooms (1) shared bedroom, (3) resident bathrooms, kitchen, staff room and laundry area. LPA observed the facility to be clean, in good repair and odor-free. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps in the kitchen. LPA observed locked toxins in the laundry room and locked medications in a nearby cabinet. LPA observed the inside temperature to be 73*F. LPA observed games/activities on site. Fire extinguisher was last serviced 6/30/22. Discussed vaccination status of residents/staff and eligibility for boosters. LPA observed multiple Covid posters throughout as well as other required postings. LPA observed (2) unlocked gates from the inside back patio. There are no bodies of water or a pool. LPA observed sufficient incontinent products and PPE products on hand. Discussed PIN 22-28.1 issued 11/29/22 regarding visitation protocols. Administrator cert #6004525740-exp 4/24/23 posted. Administrator to be transitioning from role as Administrator in the coming months. Adina Sbingu, Co-Administrator to be Administrator. LPA printed an updated license during today's inspection to reflect the current hospice waiver approved for (3) residents.

LPA obtained an updated copy of LIC500, LIC308 and the current liability insurance. There are no deficiencies issued during today's inspection.

Exit interview. Copy of report provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2022
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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