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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004196
Report Date: 11/29/2022
Date Signed: 11/29/2022 05:05:46 PM


Document Has Been Signed on 11/29/2022 05:05 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:IN LOVING HANDS CARE HOME IIFACILITY NUMBER:
347004196
ADMINISTRATOR:FLORICA SFERDIANFACILITY TYPE:
740
ADDRESS:7710 CHIPMUNK WAYTELEPHONE:
(916) 792-7664
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 5DATE:
11/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Tetyana Hankevych, Co-Administrator/caregiver and Adina Sbingu, assistant staff/Co-AdministratorTIME COMPLETED:
05:10 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met with Tetyana Hankevych, Co-Administrator/caregiver and explained purpose of inspection. LPA also met with Adina Sbingu, assistant staff person. LPA observed (2) residents in the common area and (3) residents in their rooms at the start of the inspection. LPA was advised that (1) resident is currently in the hospital. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (2). Currently, there are (0) residents on hospice. Prior to initiating today's inspection, LPA completed required COVID-19 Department protocols, wore a surgical mask and was screened per Covid-19 precautionary measures upon entering the facility.

LPA and the Co-Administrators toured the interior of the facility including the common areas, (4) resident bedrooms with private bathrooms, (1) shared bedroom with bathroom in hallway, kitchen, staff room and laundry area. The upstairs area is used by staff only. 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 posted. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps and daily medications in the kitchen. LPA observed locked toxins in the laundry room and locked medications in a closet. LPA observed the inside temperature to be 72*F. Fire extinguisher was last serviced 6/30/22. Discussed vaccination status of residents/staff, eligibility for boosters, and booster flyer provided. LPA observed multiple Covid posters throughout as well as other required postings. LPA observed (1) unlocked gate from the inside back patio. LPA observed the front and back concrete areas being power washed during the inspection. There are no bodies of water or a pool. LPA observed sufficient incontinent products and PPE products on hand. Discussed PIN 22-28.1 issued 11/29/22 regarding visitation protocols. LPA was advised that Tetyana Hankevych will be the official Administrator on/around 1/1/23. Additional paperwork to be submitted to CCLD for the change. LPA obtained an updated copy of LIC500, LIC308 copy of the current liability insurance. 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: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022
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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