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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005919
Report Date: 12/22/2021
Date Signed: 12/22/2021 04:29:38 PM

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:HEART TO HEART HOME CAREFACILITY NUMBER:
347005919
ADMINISTRATOR:FLORUTA, SERGIUFACILITY TYPE:
740
ADDRESS:5543 WILLOW OAK WAYTELEPHONE:
(916) 844-7741
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:6CENSUS: 4DATE:
12/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:19 PM
MET WITH:Lidia Floruta, LicenseeTIME COMPLETED:
04:30 PM
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Licensing Program Analysts (LPA's) Sabrina Calzada and Cassie Yang arrived unannounced to conduct a required annual. LPA's met with Licensee, Lidia Floruta and Gheorghe Flouruta, and Sergiu Floruta, Administrator, and explained purpose of inspection. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and confirmed the facility does not currently have any positive Covid-19 diagnoses. Additionally, LPA's were screened per Covid-19 precautionary measures upon entering the community. LPA's ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Facility currently has (4) residents and (2) residents are on hospice. LPA's observed (4) residents to be resting in their rooms.

LPA's and Licensee toured the interior of the facility, including (6) private resident rooms, bathrooms, kitchen, laundry room and common areas. LPA's observed it to be clean and in good repair. LPA's observed various Covid posters throughout. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA's and Licensee completed the infection control domain and facility was found to be in compliance at this time. Inside temperature was observed to be 71* F. LPA's observed sufficient 2+day perishable and 7+day non-perishable food. LPA's observed paper towels, soap, sanitizer and Covid posters and a trash can with lid in the bathrooms. LPA's observed ample PPE supply. Sharps, Toxins and medications were secured. LPA's observed required postings in the facility. LPA's and Administrator discussed vaccination status of residents and staff as well as visitation protocols per PIN 21-40 issued 8/27/2021. LPA's observed current Administrator certificates posted.

LPA requested an updated copy of LIC308 and obtained a current copy of liability insurance and LIC500. There were no deficiencies observed during today's inspection. Exit interview. Copy of report provided to Administrator.


SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
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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