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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004460
Report Date: 03/30/2022
Date Signed: 03/30/2022 03:23:16 PM


Document Has Been Signed on 03/30/2022 03:23 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:HARMONY HOME CAREFACILITY NUMBER:
347004460
ADMINISTRATOR:JOANNA BROTNEIFACILITY TYPE:
740
ADDRESS:7900 BELLINGRATH DR.TELEPHONE:
(916) 992-6032
CITY:ELVERTASTATE: CAZIP CODE:
95626
CAPACITY:6CENSUS: 0DATE:
03/30/2022
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Joanne Brotnei, LicenseeTIME COMPLETED:
04:00 PM
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On March 30, 2022, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived announced to conduct an Annual Inspection LPA met with Joanna Brotnei, Licensee and informed her the reason for the visit. Prior to initiating the inspection LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: mask.

Joanna and LPA completed the inspection tool questionnaire with no issues or advisories to report.

At this time the facility has no residents. Administrator certificate is valid. First aid kit fully stocked and ready for emergency use. Fire extinguishers fully charged. Hot water temperature measured 105 degrees F. Common areas were clean and in good repair. Bedrooms had required furniture and lighting. Facility has required (2) day perishable supply of food and (7) supply of non-perishable food.

As a result of this visit, no deficiencies were cited, per Title 22 Regulations, Division 6.

Exit interview conducted and a copy of this report given to Joanna Brotnei.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022
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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