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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004008
Report Date: 06/29/2022
Date Signed: 06/29/2022 04:37:51 PM

Document Has Been Signed on 06/29/2022 04:37 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:BALMANIA'S CARE HOMEFACILITY NUMBER:
347004008
ADMINISTRATOR:BALMANIA, ERNAFACILITY TYPE:
735
ADDRESS:8980 NEPONSET DRIVETELEPHONE:
(916) 627-1772
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 6CENSUS: 3DATE:
06/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Erna BalmaniaTIME COMPLETED:
04:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) R. Campbell and LPA MIchael Bilger conducted an unannounced Annual 1-Year Required visit on this date. LPA met and toured with Administrator, Erna Balmania. The administrator currently holds a certificate (#6002949735) that expires on 07/06/2023..

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. Chemicals were found under the sink in one of the client bathrooms. The facility consists of 4 total bedrooms of which 3 bedrooms are occupied by the clients and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature for clients is maintained at 79 degree Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured at 105 to 120 degrees Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. There is a minimum of 7-day nonperishables and 2-day perishables foods.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on June 20, 2022. First aid kit was observed to be complete and included a manual. Fire drill was last conducted on 06/16/2022

Staff records were reviewed, and all staff have criminal record clearance or a criminal record exemption and hold a current first aid certificate.

Exit interview conducted. Appeal Rights and a copy of this report provided to Administrator Erna Balmania.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2022
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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Document Has Been Signed on 06/29/2022 04:37 PM - It Cannot Be Edited


Created By: Renee Campbell On 06/29/2022 at 03:55 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: BALMANIA'S CARE HOME
FACILITY NUMBER: 347004008

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/30/2022
Section Cited

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(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.
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This requirement was not met as observed by a bathroom with unsecured chemicals under the sink.
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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:Liza King
LICENSING EVALUATOR NAME:Renee Campbell
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2022


LIC809 (FAS) - (06/04)
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