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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315003011
Report Date: 11/29/2023
Date Signed: 11/29/2023 04:01:53 PM

Document Has Been Signed on 11/29/2023 04:01 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:
11/29/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Daniel Costea, Administrator TIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a post-licensing inspection. LPA knocked on the door a few times and there was no answer. LPA called the phone number of record and left a message requesting a return call stating the reason for the inspection. LPA spoke to Alina Costea, spouse, on the phone, after she called her son and he answered the door.

Alina stated they are waiting to finish the bathroom that has been under construction, and she would call Daniel, the Administrator to meet LPA at the facility.

Daniel Costea, the Administrator, arrived at 3:15 pm and allowed LPA to enter the home and conduct a tour. LPA observed one bathroom to still be under construction. The Administrator stated he expects the bathroom to be finished and to be ready to admit residents around mid-January 2023, and he will notify the Department after the first resident is admitted. LPA did not observe any residents present.

LPA provided her business card to email photos of the finished bathroom.

There are no citations issued in this report.

Exit interview. Copy of report emailed.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2023
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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