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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045000712
Report Date: 11/19/2022
Date Signed: 11/20/2022 09:37:45 PM


Document Has Been Signed on 11/20/2022 09:37 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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:DANIELA'S COUNTRY HOME CAREFACILITY NUMBER:
045000712
ADMINISTRATOR:OLTEANU, DANIELAFACILITY TYPE:
740
ADDRESS:17 COUNTRY WOOD LANETELEPHONE:
(530) 532-1577
CITY:OROVILLESTATE: CAZIP CODE:
95965
CAPACITY:6CENSUS: 5DATE:
11/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:22 AM
MET WITH:Daniela Olteanu, LicenseeTIME COMPLETED:
11:30 AM
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On November 19, 2022, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to conduct an 1 year required annual Inspection. LPA met with Daniela Olteanu, Licensee, and explained the reason for 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; contacted licensee and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Masks.

Daniela and LPA completed the Covid infectious control questionnaire with no advisories.
LPA and Daniela toured the home. All rooms have the required furniture. The bathrooms clean. LPA observed an adequate amount of linens and found the first aid kit to be complete. There are no bodies of water on the premises. The administrator's certificate was valid expiring on August 7, 2024.

Per California Code of Regulation, Title 22, No violations was observed. No citations were issued.
The administrator shall submit updated copies of the LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610D the Emergency Disaster Plan, and copy of current Liability Insurance to update the facility file. Administrator shall submit the listed documents to Licensing no later than December 19, 2022.

An exit interview was conducted and a copy of this report was given to Daniela.

SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:
DATE: 11/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/19/2022
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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