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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700273
Report Date: 09/27/2022
Date Signed: 09/27/2022 05:02:10 PM

Document Has Been Signed on 09/27/2022 05:02 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:SIDNEY HOME CAREFACILITY NUMBER:
342700273
ADMINISTRATOR:OSELSKY, RAISAFACILITY TYPE:
740
ADDRESS:7332 SIDNEY DRIVETELEPHONE:
(916) 765-2952
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 6DATE:
09/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:Raisa Oselsky, Administrator TIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Raisa Oselsky, Administrator and Luybov Frango, caregiver, and explained purpose of inspection. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and confirmed the facility does not currently have any positive Covid-19 diagnoses. LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. There are (6) clients who reside at the home. LPA observed (6) clients in the facility and was advised (1) client is on hospice.

LPA and Administrator toured the interior and exterior of the facility including the common areas, (6) private resident bedrooms, (2) bathrooms, kitchen, laundry area. LPA was advised the Administrator resides on the property as well. LPA observed the home to be clean, safe and in good repair and to not pose a health and safety risk or personal rights violation. Inside temperature was observed to be 78* F. Fire extinguisher last serviced 4/28/2022. Facility conducts quarterly fire drills and the smoke/monoxide alarms are in working order. The facility has a back yard area with covered seating and there is an automated parking gate at the location. LPA observed sufficient 2+day perishable/7+day non-perishable food and sufficient PPE on hand. LPA observed paper towels, soap, sanitizer, trash cans, 20-second hand-washing posters by each sink. LPA observed required postings posted and Administrator certificate to be valid through 12/19/23. Discussed resident and staff vaccination status and eligibility for booster shot. LPA provided booster flyer. Discussed visitation protocols.

LPA requested updated copy of LIC308, LIC500 and current copy of liability insurance be faxed by 10/3/22.

There were no deficiencies observed. Exit interview. Copy of report left at facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2022
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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