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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315003011
Report Date: 07/25/2024
Date Signed: 07/25/2024 11:09:32 AM

Document Has Been Signed on 07/25/2024 11:09 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:LAKERIDGE SENIOR CARE LLCFACILITY NUMBER:
315003011
ADMINISTRATOR/
DIRECTOR:		COSTEA, DANIELFACILITY TYPE:
740
ADDRESS:8655 MOONEY DRIVETELEPHONE:
(916) 878-8785
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY: 6CENSUS: 0DATE:
07/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH:Daniel Costea, Administrator TIME VISIT/
INSPECTION COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived for a scheduled required annual inspection at 10:00 am. The annual was scheduled due to there not being any residents currently living at the care home. LPA met with Daniel Costea, Administrator, and Alina Costea, Licensee.

LPA, Licensee and Administrator conducted a tour inside the home and observed there were no residents present. There are (6) resident bedrooms, (2) half resident bathrooms, (4) full resident bathrooms, a staff room. Bathrooms have the necessary grab bars and non-skid flooring and common areas and (1) resident bedroom has furniture.

One of the resident bathrooms is currently undergoing remodeling and will be completed soon.

The kitchen has a locked drawer for sharps. Medications will be secured in a locked cabinet next to the kitchen. Toxins will be secured in the kitchen, laundry room and garage.

The fire extinguisher was just purchased, and the smoke/monoxide alarms are hardwired and operational.

There were several postings in the common areas. Annual fees are current.

The Administrator was advised to notify the Department when the care home becomes operational again when a first resident moves in.

There are no deficiencies issued in this report.

Exit interview. Copy of report provided to the Administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2024
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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