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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003944
Report Date: 12/09/2024
Date Signed: 12/09/2024 04:53:10 PM

Document Has Been Signed on 12/09/2024 04:53 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ELITE HOME CAREFACILITY NUMBER:
347003944
ADMINISTRATOR/
DIRECTOR:
SVETLANA, VOLOSCIUCFACILITY TYPE:
740
ADDRESS:3292 OSELOT WAYTELEPHONE:
(916) 638-8391
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY: 6CENSUS: 5DATE:
12/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:SVETLANA VOLOSCIUCTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Unannounced Annual Inspection visit was made by Licensing Program Analyst (LPA) Kimberly Viarella to this facility on 12/09/24.  LPA identified herself to the Caregiver on duty, explained the purpose of the visit, and asked to speak with Designated Facility Administrator,  Svetlana  Volosciuc.  The caregiver contacted the Administrator who arrived shortly after and a brief interview followed. Census at the time was 5 residents in care.

LPA noted the Administrator's certificate, # 6021111740 expires on 01/24/25.  Licensee stated that they renewed their certification and showed proof to LPA at the time of this visit.

The inspection began in the kitchen.  All knives and sharps were locked and inaccessible to residents in care. The food supply was adequate for 2-day perishable and 7-day nonperishable. Opened packages in the refrigerator were dated appropriately. 

LPA inspected the resident 5 bedrooms and 1 staff room.  All resident rooms had the required furniture, furnishings and lighting to be in compliance at this time.

LPA noted soap, paper towels and trash cans in bathrooms. The hot water temperature was measured at 113.1 degrees Fahrenheit and was in compliance. The fire extinguisher was last serviced on 05/08/24 by River City Fire Equipment Co. and was also in compliance.

LPA reviewed centrally stored medication log, resident medications, and the administration and destruction of medications with the Administrator. LPA also inspected the first aid kit to ensure it had all of the required components at the time of inspection.

The LPA then inspected the exterior of the facility. There were no bodies of water or outbuildings present. The yard was completely fenced in and there was a shaded sitting area for residents to enjoy.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ELITE HOME CARE
FACILITY NUMBER: 347003944
VISIT DATE: 12/09/2024
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LPA then conducted a file review for 2 clients and 2 staff. All files were in compliance at the time of this inspection.

According to the California Code of Regulations, Title 22, there were no deficiencies observed or cited during today's visit. A copy of this report was provided and an exit interview was conducted with the Administrator.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024
LIC809 (FAS) - (06/04)
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