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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315003011
Report Date: 07/13/2023
Date Signed: 07/13/2023 02:35:45 PM

Document Has Been Signed on 07/13/2023 02:35 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:LAKERIDGE SENIOR CARE LLCFACILITY NUMBER:
315003011
ADMINISTRATOR:COSTEA, DANIELFACILITY TYPE:
740
ADDRESS:8655 MOONEY DRIVETELEPHONE:
(916) 878-8785
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY: 6CENSUS: 0DATE:
07/13/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Daniel and Alina CosteaTIME COMPLETED:
03:00 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
On Thursday July 13, 2023, Licensing Program Analyst Melissa Parks arrived to conduct a prelicensing inspection.

LPA toured the facility with Licensees Daniel and Alina. This facility has a fire clearance for 6 non-ambulatory residents. There are 6 resident bedrooms and 1 staff bedroom. Water temperatures were within the required range. Showers have required nonskid mats. Kitchen is clean and organized. All knives and sharp objects are kept inaccessible to clients. All appliances in the kitchen are observed to be clean and operational. Toxins and cleaning supplies are to be kept in the laundry room. Medications will be kept locked in cabinet by the dining room. Backyard was clear of debris and hazards.

Facility has two fire extinguishers which were recently purchased. Facility has a fully stocked first aid kit.

Component III has been completed at this time with Licensees Daniel and Alina.

Facility still needs to complete construction in the hallway bathroom. Facility will only admit residents into rooms 1, 2, 3, 4, 6 until construction is complete.

The facility appears to be in substantial compliance and ready for licensure. The license will be granted upon completion of a final review and approval from the Licensing Program Manager and the Central Applications Bureau.

An exit interview was conducted with Licensees and a copy of this report was emailed to the facility.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023
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 1