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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 095002889
Report Date: 11/07/2022
Date Signed: 11/07/2022 10:10:46 AM

Document Has Been Signed on 11/07/2022 10:10 AM - 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:LIVEWELL FOR SENIORS, LLCFACILITY NUMBER:
095002889
ADMINISTRATOR:BHUPALAM, BHASKARFACILITY TYPE:
740
ADDRESS:3196 WILLISTON WAYTELEPHONE:
(916) 591-6073
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY: 6CENSUS: 0DATE:
11/07/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee, Tunde GyuricsTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPAs) Lavinia Muscan and Talwinder Bains met with applicant, Tunde Gyurics, to conduct an announced Pre- Licensing visit. LPAs followed current Covid precautions- self screened, hand sanitized and surgical mask worn. Facility Administrator will be Bhaskar Bhupalam. Administrator holds a current administrator certificate (# 6050859740 with expiration date 04/01/2023).

LPAs conducted an inspection of the care home to ensure compliance with Title 22 regulations. Facility inspection is done for these areas but not limited to five (5) bedrooms , three (3) bathrooms, storage area, outside area and laundry area . Bathrooms and bedrooms were in sanitary condition and properly maintained. LPAs checked the kitchen area for the ability to prepare and store food. Knives and Sharp objects found to be locked . LPAs observed cleaning products and other toxins to be locked away. LPAs observed the area used for medication to be locked and inaccessible to residents. LPAs observed smoke detectors and carbon monoxide detectors at the care home are operational. Fire extinguisher is ready for emergency use. Facility was approved for 6 non-ambulatory residents. Water temperature read at 120*.

Component III for RCFE was waived with Licensee during today's visit because Licensee is associated with another RCFE. LPAs will forward findings to the Centralized Application Bureau (CAB) that facility met all the pre-licensing components.

Applicant has satisfied all requirements in accordance to Title 22, California Code of Regulations on today's pre-licensing inspection. A copy of this report was provided to the facility. Exit interview conducted.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2022
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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