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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347002482
Report Date: 01/19/2024
Date Signed: 01/19/2024 04:29:32 PM


Document Has Been Signed on 01/19/2024 04:29 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: 5DATE:
01/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Adina Sbingu, Co-Administrator TIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met with Co-Administrator, Adina Sbingu, and explained purpose of inspection. Also present was caregiver, Tamara Grant. LPA observed (3) residents in the common area and (2) residents in their rooms. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (3). Currently there are (0) residents on hospice. The change in ownership is still pending.

LPA and the Co-Administrator toured the interior and exterior of the facility including the common areas, (6) private resident bedrooms, (2) staff rooms, (3) resident bathrooms, kitchen, 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 (20) second hand-washing posters. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps in the kitchen. There are locked toxins in the laundry room and locked medications in a nearby cabinet. LPA observed the inside temperature to be 74*F. The fire extinguisher was last serviced 8/1/23, and the smoke/monoxide alarms are working. There are games/activities on site. There is sufficient PPE/linens/towels and paper products. Hot water measured 120*F in the kitchen and in a resident bathroom. Door alarms work. There are (2) unlocked exits from the outside back patio. There are no bodies of water/pool. All required postings are in the common area. The Infection Control Plan (approved) and Emergency Disaster Plan were last reviewed in December 2023. LPA reviewed (3) resident files and found paperwork to be organized and current. Medications were reviewed for (3) residents - orders match medications being given. Medications are being correctly documented. LPA reviewed (4) staff files. All staff is cleared and associated and has completed required initial/continuing training. All staff has current CPR/First Aid certifications. RCFE Administrator certificate # 6004705740- was submitted for renewal in November 2023.
LPA obtained a copy of the current liability insurance and requested an updated LIC308 and LIC500 by 1/26/24. 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: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2024
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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