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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003304
Report Date: 09/20/2023
Date Signed: 09/20/2023 01:47:50 PM


Document Has Been Signed on 09/20/2023 01:47 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:HOMEVILLE CAREFACILITY NUMBER:
347003304
ADMINISTRATOR:VIERU, GABRIELAFACILITY TYPE:
740
ADDRESS:6536 NORDIC COURTTELEPHONE:
(916) 532-0061
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 5DATE:
09/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Gabriela Vieru, Administrator TIME COMPLETED:
01:50 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met with Raechel Ornelas, caregiver, and explained purpose of inspection. The caregiver contacted Administrator, Gabriela Vieru, who indicated she would be at the facility shortly. LPA observed (5) residents present. Currently, there is (1) resident on hospice. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (6).

LPA and toured the Administrator toured the interior and exterior of the facility including the common areas, resident bedrooms (4), resident bathrooms (2.5), 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, locked toxins in the laundry area and medications to be secured nearby. LPA observed the inside temperature to be 75*F. Fire extinguisher was last serviced 2/13/2023 and the smoke-monoxide alarms to be working. LPA reviewed (3) resident binders and (1) staff binder and observed them to be complete, organized and contain current documentation. Staff training records were reviewed for (1) staff - LPA observed all required training to be current. Documentation was submitted for Administrator re-certification in June 2023. Medications were reviewed for (2) residents and no discrepancies were found. Administrator certificate #6007196740- exp 9/18/2023 is posted along with other required postings. LPA reviewed/approved the facility's Infection Control Plan, submitted in August 2023. LPA observed newly added room (#6) to be complete and occupied by a resident. All staff is fingerprint cleared. Roster was updated by the Administrator with names to disassociate. LPA observed (1) unlocked gate from the inside back patio. There are no bodies of water or a pool. There is also a front enclosed patio area where residents can have visitors. LPA obtained an updated copy of current liability insurance, LIC500 and LIC308.
There are no deficiencies issued during today's inspection. Exit interview with Administrator. Copy of report provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2023
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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