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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002851
Report Date: 02/07/2022
Date Signed: 02/08/2022 09:21:03 AM

Document Has Been Signed on 02/08/2022 09:21 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:LIVING AT HOME SENIOR CAREFACILITY NUMBER:
315002851
ADMINISTRATOR:PLOSCEANU, GHEORGHEFACILITY TYPE:
740
ADDRESS:2747 CAMPBELL DRTELEPHONE:
(916) 607-7679
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY: 6CENSUS: 0DATE:
02/07/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Gheorghe and Sorina PlosceanuTIME COMPLETED:
01:30 PM
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On 2/7/2022 LPA Tryon visited the facility to do a pre-licensing visit. LPA met with applicants Gheorghe and Sorina Plosceanu. LPA toured the house including common areas, kitchen, bedrooms, bathrooms, storage, garage, yard. The facility has sufficient food supplies, dishes, cooking supplies, utensils, etc.

LPA went through the inspection tool pre-licensing section with the applicants.

At this time the facility appears to be generally in compliance with the regulations.

During the visit, LPA reviewed the RCFE Orientation Component III with the applicants. Component III has been completed,

The home is in the process of obtaining Liability Insurance once the facility obtains a license.

At this time, LPA will forward this information to the Centralized Application Bureau to continue the application process.

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2022
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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