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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002800
Report Date: 07/26/2021
Date Signed: 07/26/2021 11:38:42 AM

Document Has Been Signed on 07/26/2021 11:38 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:SADDLEBACK LOVING HEARTSFACILITY NUMBER:
315002800
ADMINISTRATOR:MAGUREAN, TATIANAFACILITY TYPE:
740
ADDRESS:3400 BLUE GRASS DR.TELEPHONE:
(916) 844-7330
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY: 6CENSUS: 0DATE:
07/26/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Tatiana MagureanTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) K. Hiratsuka, arrived at the facility announced on 07/26/2021 to conduct an announced prelicensing visit. LPA met with Tatiana Magurean, and explained the purpose of the visit. Prior to initiating the prelicensing 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 applicant 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: surgical mask. Additionally, LPA was screened by Tatiana Magurean.

This facility has a fire clearance for five non-ambulatory and one bedridden residents. This facility has six private resident rooms and one staff room. The main entrance opens to the main common area. To the left of the main entrance is the kitchen. To the left of the kitchen is a storage room that also has a half-bathroom. The main common area has the sitting and dining areas. On the left of the main common area is a hallway that leads to three private resident rooms, one full common bathroom, and caregiver room. Two of the resident rooms have half private bathrooms and exits to the outside. To the right of the main entrance is a hallway that leads to three private resident rooms. Two of the rooms have full private bathrooms and one has a half private bathroom. One room has an exit to the outside. The laundry machines are located in the hallway on the right. There is no connection between the facility and garage. There is a deck that surrounds the facility. The yard was inspected. This property has several acres and there is a walking path for residents. The front yard has a fountain that has rocks in it to prevent it from being a drowning hazard because there is no water that collects.

Component III orientation was waived by LPA because Administrator already operates another facility.

This facility meets licensing regulations. LPA is going to submit this report to application specialist.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2021
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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