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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001629
Report Date: 01/20/2023
Date Signed: 01/20/2023 12:47:53 PM

Document Has Been Signed on 01/20/2023 12:47 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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:MARIA'S HOME CAREFACILITY NUMBER:
347001629
ADMINISTRATOR:ANDREI COSTEAFACILITY TYPE:
740
ADDRESS:5914 CANARY DRIVETELEPHONE:
(916) 344-5487
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY: 6CENSUS: 5DATE:
01/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:28 AM
MET WITH:Costea Andres, AdministratorTIME COMPLETED:
01:14 PM
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On January 20, 2023, Licensing Program Analyst (LPA), DeAnna Williams-Lyons, arrived unannounced to conduct a 1 year required inspection. LPA met with Costea Andrea,, Administrator, and informed him the reason for the visit. Prior to the visit, LPA completed required COVID-19 testing protocols, a daily self-screening questionnaire for symptoms of COVID-19, and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and wore a mask for Personal Protective Equipment (PPE). The Administrator Certificate expires September 28, 2023.. The facility's temperature was 73 degrees.

Costea and LPA conducted the infectious Control questionnaire with no issues.

LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, and kitchen. In the kitchen area, cabinets and drawers were reviewed. Knives and sharp objects were reviewed and inaccessible to the residents. LPA observed there to be a sufficient amount of 2-day perishable and 7-day non-perishable food. Hot water temperature was taken and measured 118 degrees F .

Living room, dining room, and areas designated for resident use were toured. Furniture and furnishings were observed to be sufficient and in good repair. Resident bedrooms and bathrooms were toured. There are 4 Bedrooms and 2 bathrooms for residents.
To continue see 809-C..
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE: DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/20/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: MARIA'S HOME CARE
FACILITY NUMBER: 347001629
VISIT DATE: 01/20/2023
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All rooms had the required items of furniture. Window screens were on and in good repair. Bathrooms were clean, sanitary and odorless and consisted of grab bars and non-skid mats. First aid kit was complete, smoke alarms were functional, and fire extinguisher were ready for use. There’s a centralized storage area for resident’s medication. Medication cabinet was locked.

LPA inspected the exterior of the grounds. There are no bodies of water on the premises. The perimeter fence, side gates, and latches were in good repair. Passageways are free of obstruction and potential hazards.

No Deficiencies observed or cited during this visit per Title 22 Regulations.

The administrator shall submit updated copies of the LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610D the Emergency Disaster Plan, and copy of current Liability Insurance to update the facility file at the Regional Office. Administrator shall submit the listed documents to Licensing no later than February 20, 2023.

Exit interview was conducted with Costea and a copy of this report was given.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023
LIC809 (FAS) - (06/04)
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