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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004196
Report Date: 01/15/2025
Date Signed: 01/15/2025 01:07:39 PM

Document Has Been Signed on 01/15/2025 01:07 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:IN LOVING HANDS CARE HOME IIFACILITY NUMBER:
347004196
ADMINISTRATOR/
DIRECTOR:		TETYANA HANKEVYCHFACILITY TYPE:
740
ADDRESS:7710 CHIPMUNK WAYTELEPHONE:
(916) 910-9827
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
01/15/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Tetyana Hankeych, Administrator TIME VISIT/
INSPECTION COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual and met with Andrii Chornei, caregiver, and stated the reason for today's inspection. Administrator, Tetyana Hankeych, arrived by 10:00 am to assist with the inspection. LPA observed all residents to be in their rooms at the start of the inspection. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (2). Currently there are (2) residents on hospice. LPA observed (2) nurses (hospice and home health), and a hospice care aide present during today's inspection.

LPA and the Administrator toured the interior/exterior of the facility including the common areas, (6) resident bedrooms, (4) half-bathrooms and (1) main bathroom, kitchen, staff room, garage and locked laundry area. The upstairs area is not used by residents and has a locked gate for staff access only. LPA observed the facility to be clean, in good repair and odor-free, and the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters. Hot water measured 118*F in a resident bathroom. LPA observed sufficient 2+day perishable/7+day non-perishable supply of food and locked sharps in the kitchen. Toxins are secured in the laundry room and medications are locked in a separate cabinet. The inside temperature was 74*F. Smoke/monoxide alarms are in working order, fire door in compliance, and the fire extinguisher was last serviced 8/2/24. There is a covered patio with seating and (1) unlocked gate.

LPA reviewed (3) resident files and found them to be organized and contain current paperwork. LPA observed sufficient linens/blankets/incontinent/PPE supplies, and a complete First Aid kit. Medications were reviewed for (1) residents and no discrepancies noted. Medication documentation is current/accurate. (4) staff files were reviewed- staff has completed initial/ongoing training. All staff is cleared/associated and has current First Aid/CPR certifications. LPA obtained a copy of the current liability insurance and requested LIC500 and LIC308. Administrator certificate #7010593740- exp 8/8/25. There are no deficiencies issued during today's inspection. Exit interview with Administrator. Copy of report provided.
Maribeth SentyTELEPHONE: (916) 263-4813
Sabrina CalzadaTELEPHONE: (510) 829-2133
DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/15/2025
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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