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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004460
Report Date: 03/06/2024
Date Signed: 03/06/2024 12:23:16 PM


Document Has Been Signed on 03/06/2024 12:23 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



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:
03/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Administrator- Joanna BrotneiTIME COMPLETED:
12:25 PM
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On 03/06/24 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a Required 1- Year Inspection utilizing the care tool. LPA met with administrator, Joanna Brotnei, and explained the purpose of the visit.

LPA and Administrator conducted a tour of the facility. Area toured included but not limited to the kitchen, dining room, bedrooms and bathrooms, common areas and backyard. LPA observed sufficient furniture and lighting throughout the facility. Hot water temperature was measured at 107.2 degrees Fahrenheit in the kitchen sink which is within the required range of 105 to 120 degrees. Fire extinguisher was last inspected on 02/28/24 Smoke detectors are current and in compliance with fire safety including carbon monoxide detector.

Currently there are no residents living in facility. Administrator will let Community Care Licensing know when they accept a resident.

No deficiencies are being cited as a result of today’s inspection.

Exit interview conducted and copy of report left at the facility.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Cheyenne RatajczakTELEPHONE: (916) 969-7879
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2024
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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