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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003944
Report Date: 12/04/2023
Date Signed: 12/04/2023 01:13:36 PM


Document Has Been Signed on 12/04/2023 01:13 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:ELITE HOME CAREFACILITY NUMBER:
347003944
ADMINISTRATOR:SVETLANA, VOLOSCIUCFACILITY TYPE:
740
ADDRESS:3292 OSELOT WAYTELEPHONE:
(916) 638-8391
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY:6CENSUS: 5DATE:
12/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Svetlana Volosciuc - AdministratorTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Ruth Wallace conducted a required 1 year annual inspection. LPA met with administrator and explained purpose of visit. Administrator certificate expires 1/24/2025. Currently there are three residents on hospice.

LPA and Administrator evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility.

LPA measured the water temperature, temperature measured at 110.3 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers were last inspected on 5/9/2023. Smoke detectors are current and in compliance with fire safety. LPA notes the facility had required carbon monoxide detectors. First aid kit was checked and is complete. Fire Drill last conducted on 11/4/2023. Liability Insurance expires 7/1/2024.

LPA observed centrally stored medications secure from residents. LPA reviewed three resident and two staff files, including criminal record clearances. All staff are fingerprint cleared and associated to the facility.

Per California Code of Regulations, Title 22 there were no deficiencies cited during today's inspection.

An exit interview was conducted with administrator. A copy of this report and LIC 811 (Confidential Names) was left at the facility.

SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 253-4746
LICENSING EVALUATOR NAME: Ruth WallaceTELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:
DATE: 12/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/04/2023
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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