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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004242
Report Date: 07/12/2023
Date Signed: 07/12/2023 02:28:19 PM

Document Has Been Signed on 07/12/2023 02:28 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:A GARDEN OF PARADISE CARE HOMEFACILITY NUMBER:
347004242
ADMINISTRATOR:OKSANA DOLDIERFACILITY TYPE:
740
ADDRESS:7789 SPENCER LANETELEPHONE:
(916) 878-9811
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 4DATE:
07/12/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Oksana Doldier, Administrator TIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection following a recent updated fire clearance. LPA met with Oksana Doldier, Administrator, and explained purpose of inspection. LPA observed Administrator's spouse, Michael Doldier, also present at the facility and (1) resident resting in the common area. Currently, there are (4) residents and was advised (1) resident is under hospice care. The facility is licensed for (6) non-ambulatory residents and has an approved hospice waiver for (4).

The updated fire clearance, issued 7/10/23, grants approval for (4) non-ambulatory residents to reside in (4) newly constructed private resident rooms and (2) non-ambulatory residents to remain living in (2) private resident rooms in the existing portion of the house, for a total of (6) residents. The prior fire clearance granted authorization for (1) shared resident room and (4) private resident rooms, all non-ambulatory.

Administrator stated she has a resident that wishes to remain in a room in the existing building instead of moving to one of the newly constructed rooms and asked about increasing the total capacity from (6) to (8) residents. LPA explained the process to request an increase in capacity, referencing Health and Safety Code 1569.185(b)(1)(C). Administrator stated she would provide the Department with a completed LIC200, fee and updated facility sketch to reflect her request that a fire clearance be approved for (8) non-ambulatory residents, (4) residents residing the existing house and (4) residents residing in the newly added resident rooms. Administrator wishes to maintain the approved hospice waiver for (4) residents.

LPA toured both the existing and new sections of the house and observed (3) residents to be present in the existing portion and (1) resident to be present in the new section. LPA did not observe any health and safety risk or personal rights violation during today's inspection. LPA observed newly installed fences, patio lights, patio furniture and umbrellas.
There are no deficiencies issued on this report. Exit interview. Copy of report provided to the Administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2023
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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