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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045001839
Report Date: 02/21/2024
Date Signed: 02/21/2024 12:14:24 PM


Document Has Been Signed on 02/21/2024 12:14 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:IRIS CARE HOMEFACILITY NUMBER:
045001839
ADMINISTRATOR:ANGHELUTA, NICOLETAFACILITY TYPE:
740
ADDRESS:4117 LOWER WYANDOTTE RD.TELEPHONE:
(530) 534-7996
CITY:OROVILLESTATE: CAZIP CODE:
95966
CAPACITY:8CENSUS: 8DATE:
02/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Nicoleta Angheluta - licensee/administratorTIME COMPLETED:
12:15 PM
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02/21/2024 10:30 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with licensee/administrator Nicoleta Angheluta ( 6011213740 exp. 01/05/2024 ) and explained the purpose of the visit.

LPA Knight and the administrator toured the facility together to ensure the health and safety of clients in care. Areas toured include but are not limited to six (6) resident rooms, common areas, three (3) bathrooms, kitchen, storage areas and back yard. Staff and resident files were reviewed. All employees requiring background checks are cleared. Administrator certificate expired 01/05/2024. The administrator submitted for renewal in November 2023 and has not received the updated certificate to date.

There is a schedule of recreational activities planned for the clients. Bedding, linens, and towels for clients were observed and found to be clean and in good repair. There is an adequate supply of toiletries for the clients. Medication is locked in a cabinet.

The facility was observed to be at a comfortable temperature. Hot water measured between 105 – 120 degrees F. Common area was clean and in good repair. All bedrooms had required furniture, bedding, and lighting. Bathrooms were clean and in good repair. Kitchen was clean and in good repair. Food appears to be stored and prepared properly. Facility has required (7) seven-day non-perishable and (2) day perishable supply of food. Fire extinguishers fully charged and were inspected by the fire marshall. Smoke detectors are all operational. No pools/bodies of water are on premises. No firearms are on premises. The facility has been conducting disaster drills every 2 months.

LPA requested licensee to submit the following documents to LPA to update facility file: Updated Emergency Disaster Plan LIC610E.

In the areas toured no immediate health, safety, or personal rights violations were observed. No deficiencies are being cited as a result of today’s inspection.

Exit interview conducted and copy of report was provided to licensee/administrator Nicoleta Angheluta.

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2024
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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