347004242-1-10-2023-25-AS-SCAA-CMXTP8-20230110135357

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 347004242
Report Date: 01/10/2023
Date Signed: 01/10/2023 01:54:05 PM

Document Has Been Signed on 01/10/2023 01:54 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:	A GARDEN OF PARADISE CARE HOME		FACILITY NUMBER:	347004242
ADMINISTRATOR:	OKSANA DOLDIER		FACILITY TYPE:	740
ADDRESS:	7789 SPENCER LANE		TELEPHONE:	(916) 878-9811
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	6	CENSUS: 5	DATE:	01/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Oksana Doldier, Administrator		TIME COMPLETED:	01:55 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Oksana Doldier, Administrator, and explained purpose of inspection. LPA observed Administrator's spouse, Michael Doldier, also present at the facility. LPA observed all (5) residents to be in their rooms at the start and duration of the inspection. Currently, there is (1) resident on hospice. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (4). Prior to initiating today's inspection, LPA completed required COVID-19 Department protocols and confirmed the facility does not currently have any positive Covid-19 diagnoses. LPA was screened per Covid-19 precautionary measures upon entering the facility wore a surgical mask.. LPA and Administrator toured the interior and exterior of the facility including the common areas, resident bedrooms (5), (2) resident bathrooms, kitchen, laundry area and garage. Additionally, there are (4) unoccupied bedrooms, each with a full bathroom, that will be used as resident rooms once approval is granted by the fire department and licensing. Administrator stated she would like to increase the capacity from (6) to (8). Administrator to notify the Department when ready for fire inspection. 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 20-second hand-washing posters posted. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps and medications in the kitchen and locked toxins to be secured nearby. LPA observed the inside temperature to be 77* F. Fire extinguisher was last serviced 2/4/2022 and facility conducts quarterly fire drills. Discussed vaccination status of residents/staff, eligibility for boosters and visitation protocols. Booster flyer provided. LPA observed multiple Covid posters as well as other required postings, including several Provider Information Notice (PIN) from the Department. Administrator to post updated PIN's to reflect recent guidance. and also a "Mask Required" poster outside the front entrance. cont on 809C(1)..

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: A GARDEN OF PARADISE CARE HOME	FACILITY NUMBER: 347004242
	VISIT DATE: 01/10/2023

NARRATIVE

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809C(1)...All staff is fingerprint cleared and associated and has current First Aid/CPR and other required training. LPA observed (1) unlocked gate from the inside back patio. There are no bodies of water or a pool. LPA observed a portion of the backyard fence to be on the ground due to the recent storms. LPA observed new fencing materials on site and Administrator stated it will be repaired as soon as the weather allows it. LPA observed (2) tables with seating and umbrellas as well as a cement circular walkway for walking.

LPA observed RCFE Administrator Certificate # 60079637340- exp 12/12/2023 for current Administrator posted.

LPA observed sufficient incontinent products and PPE on hand as well as an unopened First Aid kit, new flashlight and bottled water.

LPA reviewed (3) of (5) resident files and found them to be complete and contain current documentation.

LPA obtained an updated copy of LIC500, LIC308 and current liability insurance today.

LPA printed an updated copy of the facility license to reflect an approved hospice waiver for (4) residents.

There are no deficiencies issued during today's inspection.

Exit interview with Administrator. Copy of report provided.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2023

LIC809 (FAS) - (06/04)

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