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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002307
Report Date: 07/27/2021
Date Signed: 07/27/2021 12:36:41 PM

Document Has Been Signed on 07/27/2021 12:36 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:ESTERA'S HOME CARE IIFACILITY NUMBER:
315002307
ADMINISTRATOR:NICULAI, ESTERAFACILITY TYPE:
740
ADDRESS:1744 WOODLEAF CIRCLETELEPHONE:
(916) 257-3621
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY: 5CENSUS: 0DATE:
07/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Estera Niculai (Admin)TIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Konnor Leitzell arrived at the facility on 07/27/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain, LPA met with Estera Niculai (Admin) 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; contacted admin 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 Masks.

Prior to entering facility, LPA was informed facility currently does not have no clients in care, and has not had clients in care since originally being licensed. Facility is up to date on licensing fees. LPA asked if licensee plans to open facility for operation, and was informed licensee is unsure of future plans with facility, but will notify Community Care Licensing if plans to open.

LPA and Admin completed the Infection Control Domain Tool.

LPA and Admin completed exit interview. No deficiencies are cited as a result of todays inspection. Report left at facility.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Konnor Leitzell
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2021
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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