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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347002482
Report Date: 08/11/2023
Date Signed: 08/11/2023 04:26:54 PM


Document Has Been Signed on 08/11/2023 04:26 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: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: 6DATE:
08/11/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Florica Sferdian, Co-Administrator and Adina Sbingu, Co-Administrator TIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection to follow up on information received from the local fire department. LPA met with Kay-Ann Clarke caregiver, and explained purpose of inspection. Florica Sferdian, Co-Administrator, arrived at the facility from a related facility nearby. LPA observed Klara Csatari, caregiver, cooking in the kitchen, LPA also met with Adina Sbingu, Co-Administrator, who arrived at approximately 3:15 pm.

LPA discussed recent fire clearance concerns with Adina and Florica and observed a new fire door (smaller dimensions 36") to have been recently installed (today). The door was added as part of what is needed for a new fire clearance with the pending change in ownership.
LPA and Adina toured the interior and exterior of the facility and discussed the following:
  • 1 storage room that was added when the outdoor kitchen was built and 1 room that was converted to a staff room from the jacuzzi room. This was not added to the floor plan at the time.
  • A heat detector (similar to a smoke detector) needs to be connected to all of the interconnected smoke/monoxide alarms. The pull station alarms can be taken down once fire approves.
  • The accordion wall separating the formal dining area from the living room was removed in January 2023 and dry wall construction was completed. A permit was not taken out for this construction.
  • A permit was taken out on 8/10/23 specifically for: 120 sq feet interior altercation; add an exit door to bedroom #1, add a fire door to bedroom #2 and at the hallway entry. Construction is expected to start next week.
LPA reviewed the original fire sketch/floor plan submitted in August 2003. The floor plan was never updated to include the storage room and room adjacent to the outdoor kitchen. LPA observed (6) residents present and to be residing in bedrooms #1,2,3,4,5 and 6, as approved per fire clearance (6-non-ambulatory). LPA observed the facility to be clean, in good repair and odor free.
Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (1) deficiency is cited on the 809-D page. Exit interview. Copy of report and appeal rights provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 08/11/2023 04:26 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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


FACILITY NAME: IN LOVING HANDS CARE HOME
FACILITY NUMBER: 347002482

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/25/2023
Section Cited
CCR
87305(a)

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87305 Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirement is not met as evidenced by:
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Licensee/Administrator agrees to apply for a building permit before beginning any alterations to an existing building or new facility and to also speak with fire when needed. Licensee/Administrator obtained a permit on 8/10/23 on-line for the construction that was started today.
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Based on interview with Co-Administrator, in Jauary 2023, dry wall was added in the living room area to replace an accordion door and a city permit was not taken out, which poses a potential health and safety risk to residents in care.
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There is no further action needed for POC.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2023
LIC809 (FAS) - (06/04)
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