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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005547
Report Date: 08/19/2022
Date Signed: 08/19/2022 04:17:35 PM


Document Has Been Signed on 08/19/2022 04:17 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:CORINA ELDERLY HOMEFACILITY NUMBER:
347005547
ADMINISTRATOR:DRAGNEA, CORINAFACILITY TYPE:
740
ADDRESS:8840 KELSEY DRIVETELEPHONE:
(916) 215-0365
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 5DATE:
08/19/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Corina DragneaTIME COMPLETED:
04:22 PM
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On 8-19-22 at 2:15pm, LPAs Michael Bilger and Renee Campbell arrived unannounced to conduct a case management visit regarding a previous visit on 6-16-22. LPAs met with Administrator Corina Dragnea and explained the purpose of the visit. LPAs conducted a facility observation and interviewed 2 residents. LPAs also interviewed Administrator and reviewed resident file documentation for Resident1 (R1), R2, R3, R4, and R5.. Based on facility observation and interview, it was determined that none of the current residents meet the regulatory definition of bedridden. It was also determined that Administrator does not currently possess a bedridden clearance. Residents in care were observed to ambulate with walkers and turn and reposition independently in bed.

No deficiencies cited today. An exit interview was conducted with Corina Dragnea and a copy of this report was left with Corina.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:
DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/19/2022
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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