<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700425
Report Date: 05/24/2021
Date Signed: 05/24/2021 12:08:59 PM

Document Has Been Signed on 05/24/2021 12:08 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:PLACER STARCAREFACILITY NUMBER:
312700425
ADMINISTRATOR:BALAS-IRIMESCU, DAMIANAFACILITY TYPE:
740
ADDRESS:6814 CAMBORNE WAYTELEPHONE:
(916) 412-2758
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY: 6CENSUS: 5DATE:
05/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Damiana Balas-Irimescu, administratorTIME COMPLETED:
12:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Wolter arrived at the facility unannounced on 05/24/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain, LPA met with staff, Crystal Smith and explained the purpose of the visit. Prior to initiating the annual inspection, 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 and 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: N-95 Mask. Additionally, LPA was screened by facility staff upon entry.

LPA and staff toured the facility together to ensure health and safety of residents in care, areas inspected include but are not limited to: common areas, resident bedrooms and bathrooms, kitchen, garage, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed.

Administrator, Cristian Irimescu arrived at the facility during inspection, LPA and administrator started the infection control domain together, LPA finished infection control with Damiana "Dee" Irimescu-Balas and facility was found to be in substantial compliance at this time.

In the areas inspected, no deficiencies are being cited.
Exit interview conducted and copy of report left at the facility.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Danyle Wolter
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2