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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005371
Report Date: 06/22/2023
Date Signed: 06/22/2023 11:58:36 AM


Document Has Been Signed on 06/22/2023 11:58 AM - 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:AAA CAREFACILITY NUMBER:
347005371
ADMINISTRATOR:MICLEA, DAVIDFACILITY TYPE:
740
ADDRESS:8445 OLD AUBURN ROADTELEPHONE:
(916) 242-0907
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 0DATE:
06/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator, David MicleaTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Angela Hood arrived at the facility on 6/22/23 to conduct a Required-1 Year Inspection utilizing the inspection tool.

LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are currently no residents residing at the care home. There are six (6) bedrooms and two (2) bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition, properly maintained, and the hot water temperature was observed to be 113.3 degrees F.

LPA checked the kitchen area for the ability to prepare and store food. The facility has a locked cabinet that will be used for medications. Smoke detectors and carbon monoxide detector are operational. Fire extinguisher is maintained and ready for emergency use.

LPA reviewed one staff file. Facility provided a current copy of certificate of liability insurance to LPA.

As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit interview conducted and copy of report given at the conclusion of this visit.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Angela HoodTELEPHONE: 650-676-0390
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2023
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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