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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005391
Report Date: 08/19/2021
Date Signed: 08/19/2021 11:29:39 AM

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:CARE HORIZONS ASSISTED LIVINGFACILITY NUMBER:
347005391
ADMINISTRATOR:IORDACHE-STIR, ADRIANFACILITY TYPE:
740
ADDRESS:6630 CARE LANETELEPHONE:
(916) 721-2073
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 6DATE:
08/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator, Adriana Iordache-StirTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Melana Llopis arrived at the facility unannounced on 08/19/2021 for a Required - 1 Year inspection. LPA met with Administrator, Adriana Iordache-Stir and explained the purpose of the visit.
Prior to the visit, 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; upon entering LPA completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by Marlene Scarlett, staff (S1), upon entering the facility.

LPA and Administrator toured the facility together. Areas inspected include but are not limited to the following: living room, kitchen, dinning room, resident bedrooms and bathrooms, staff bedroom and bathroom, laundry room and backyard. LPA found facility to be free of odor and in good repair. LPA found sharps and toxins to be locked and inaccessible to residents in care. LPA observed there to be an adequate supply of 7 day nonperishable food items and 2 day perishable food items. LPA found the fire extinguisher to be last serviced on 1/17/2021 and fully charged. Smoke detectors and carbon monoxide devices were tested and found in working order. LPA measured the water temperature at 102 degrees F. LPA observed resident bedrooms to have required furniture and sufficient lighting. LPA found resident bathrooms to have grab bars and nonskid mats. LPA found first aid kit to be complete. LPA reviewed infection control procedures and found facility to be in compliance.

LPA reviewed two (2) resident files and two (2) staff files. LPA found files to be complete and staff to be associated to facility and have current CPR and first aid training.

As a result of today's visit, no deficiencies are being cited.
Exit interview conducted, copy of report provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melana LlopisTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
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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