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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347002550
Report Date: 11/02/2021
Date Signed: 11/02/2021 05:07:10 PM

Document Has Been Signed on 11/02/2021 05:07 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:HARMONY HOMEFACILITY NUMBER:
347002550
ADMINISTRATOR:CATA, CORNELIAFACILITY TYPE:
740
ADDRESS:5000 MELVIN DRIVETELEPHONE:
(916) 485-5541
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 6CENSUS: 6DATE:
11/02/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:Cornelia Cata, 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 Emidio Arreola, caregiver. Administrator, Cornelia Cata, arrived shortly to the facility and LPA 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. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Facility currently has (6) residents and (2) residents are on hospice. LPA observed (5) residents to be in their rooms and (1) resident watching television in the common area. Facility has (2) live-in caregiver staff.

LPA and Administrator toured the interior of the facility. LPA observed it to be clean and in good repair. LPA observed various Covid posters throughout- LPA to send additional posters. Rooms toured include (6) private bedrooms with half/full bath, kitchen, laundry, staff room and common areas. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA, Administrator and caregiver completed the infection control domain and facility was found to be in compliance at this time. Inside temperature was observed to be 74* F. Fire extinguisher last serviced 1/14/2021. LPA observed sufficient 2+day perishable and 7+day non-perishable food. LPA observed paper towels, soap, sanitizer and trash cans with lids in the bathrooms. Sharps, toxins and medications are secured appropriately. LPA and Administrator discussed vaccination status of residents and staff.

LPA requested an updated copy of LIC308 and obtained a copy of the current liability insurance and Administrator certification.

There were no deficiencies observed during today's inspection. Exit interview. Copy of report provided to Administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2021
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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