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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005162
Report Date: 03/22/2023
Date Signed: 03/22/2023 12:49:20 PM

Document Has Been Signed on 03/22/2023 12:49 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:LOVE AND DIVINE HOME CAREFACILITY NUMBER:
347005162
ADMINISTRATOR:SARCADI, DENISFACILITY TYPE:
740
ADDRESS:6525 GREENHAVEN DRIVETELEPHONE:
(916) 591-0801
CITY:SACRAMENTOSTATE: CAZIP CODE:
95831
CAPACITY: 6CENSUS: 1DATE:
03/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Denis SarcadiTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required – 1 Year inspection on 3/22/23 at 10:45am. LPA met with Denis Sarcadi, Licensee and stated the purpose of today’s visit. LPA was allowed entry into the facility that is licensed to serve a total capacity of 6 residents. License fees are current. Administrator certificate expires 9/19/2023 for Denis Sarcadi. There is a hospice waiver for 1 approved. There are 0 residents utilizing hospice services at this time.

The physical plant was toured inside and outside to ensure the safety of the residents. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, central heating and air in the facility. The temperature inside the facility was measured at 74*F which is within the required range of 68 degrees F (20 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat the maximum shall be 30 degrees F (16.6 degrees C) less than the outside temperature. The hot water was measured at 117.4*F which is not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C) as per Title 22 regulations. LPA observed the centrally stored medications area to be locked and inaccessible to clients.
The first aid kit was found in compliance containing at least the following: a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency, sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and antiseptic solution. LPA observed food supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days which shall be maintained on the premises at all times.

Upon a file review the following items were discussed to be submitted with any changes annually:
Designation of Administrative Responsibility LIC308, Liability Insurance-current, Personnel Report LIC500
Qualifications of Administrator/Facility Manager-updated certificate

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies observed or cited. Exit interview held, copy of report given.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2023
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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