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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920223
Report Date: 03/11/2025
Date Signed: 03/11/2025 03:58:43 PM

Document Has Been Signed on 03/11/2025 03:58 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:CARING HEART RESIDENTIALFACILITY NUMBER:
315920223
ADMINISTRATOR/
DIRECTOR:		ABUREKHANLEN, ELOMENSEFACILITY TYPE:
740
ADDRESS:4032 NEWMARKET ST.TELEPHONE:
(916) 841-5941
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY: 6CENSUS: 0DATE:
03/11/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:35 PM
MET WITH:Elomense Aburekhanlen, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA) Cassandra Mikkelson and Cheyenne Ratajczak arrived at the facility and met with Administrator, to conduct a Pre- Licensing visit. The facility has a fire clearance for four (4) non-ambulatory residents and two (2) ambulatory residents in bedroom #1. Administrator has an active certificate (#6071118740 with expiration date 06/06/2026).

LPAs conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are four (4) bedrooms and two (2) bathrooms for resident use. Bathrooms were in sanitary condition and properly maintained. LPAs observed facility has the ability to prepare and store food, to lock away cleaning products and other toxins, and lock medications to make inaccessible to residents. First aid kit is maintained and ready for emergency use.

LPAs observed smoke alarm over bedroom 1 is not functioning properly and hot water temperature was 97.1 degree F. LPAs informed Applicant another pre-licensing inspection will be conducted Thursday March 13, 2025.

Component III was completed. A copy of this report was provided to the facility. Exit interview conducted.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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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