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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003894
Report Date: 02/23/2026
Date Signed: 02/23/2026 11:45:04 AM

Document Has Been Signed on 02/23/2026 11:45 AM - 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ELENA'S CARE HOMEFACILITY NUMBER:
347003894
ADMINISTRATOR/
DIRECTOR:		ROZPADNYUK, ELENAFACILITY TYPE:
735
ADDRESS:6800 CASA DEL ESTE WAYTELEPHONE:
(916) 379-9828
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY: 4CENSUS: 4DATE:
02/23/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:27 AM
MET WITH:Elena RozpadnyukTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On February 23, 2026, Licensing Program Analyst (LPA) Arvin Villanueva arrived unannounced to conduct the facility’s annual inspection. Upon arrival, LPA met with Licensee/Administrator, Elena Rozpandhyuk (AD), and explained the purpose of the visit.
Facility Overview
The facility is a one-story home located in a residential neighborhood and is licensed to serve up to four adult residents. Bedroom #1, on the facility sketch, was approved for non-ambulatory use. The facility manages residents’ cash resources and is vendored by Alta California Regional Center (ACRC).
Initial Observations
At the time of LPA’s arrival, one resident and one staff member were present; one additional resident arrived later. Required postings and the facility license were observed. The room temperature was 70°F upon arrival.
Physical Inspection
The inspection included, but was not limited to, the kitchen, resident bedrooms, bathrooms, living and dining areas, and outdoor spaces. LPA inspected all four resident bedrooms and two bathrooms. Hot water temperature measured 111°F in the hallway.
A fire extinguisher was observed in the dining area, last serviced on 1/12/2026. Smoke detectors were present throughout the facility, and at least one carbon monoxide detector was observed. Medications, toxins, sharp objects, and other hazardous items were locked and inaccessible to residents.
In the kitchen, LPA noted a sufficient 2-day perishable and 7-day nonperishable food supplies. Advisory was provided to AD to obtain thermometers for all the freezers and refrigerator to ensure regulatory temperature is maintained.

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NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Arvin Villanueva
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ELENA'S CARE HOME
FACILITY NUMBER: 347003894
VISIT DATE: 02/23/2026
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Inspection of the garage: LPA observed 2 additional freezers, laundry machine, and additional food supplies. Sharps, laundry soaps and cleaning supplies were observed in a locked cabinet.

The outdoor space included a shaded area with furniture for resident use. Ramps were in good repair, and emergency exits were unobstructed. Fence in good repair at this time. The exit gate requires repair, as it drags along the ground when opened. No pool or bodies of water were observed.

Record Review
LPA reviewed four resident files, including Admission Agreements, Physician Reports, Needs and Services Plans, Centrally Stored Medication Records, and Ambulatory Status. Medication was reviewed for two residents; and cash resource (P&I) records were reviewed for all four residents.
Three staff files were reviewed, including, but not limited to, background clearance, First Aid/CPR certification, health screening, and training records. The Administrator holds a current Administrator Certificate. Staff were verified through Guardian.
First Aid Kit was reviewed and found to be complete.
Fire and disaster drill records were reviewed; drills are conducted monthly. LPA advised AD to review and document the facility’s disaster and infection control plans annually.

Documents Requested: LPA requested a copy of updated Liability Insurance Certificate, Surety Bond, LIC500, LIC610 and LIC308 to be emailed to arvin.villanueva@dss.ca.gov.

Per the California Code of Regulations, Title 22, Division 6, Chapter 1 & 6, no deficiencies were cited. Advisories were provided.

Exit interview was conducted. A copy of the report was provided upon exit.

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NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Arvin Villanueva
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2026
LIC809 (FAS) - (06/04)
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