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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005371
Report Date: 06/24/2021
Date Signed: 06/24/2021 02:41:32 PM

Document Has Been Signed on 06/24/2021 02:41 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:AAA CAREFACILITY NUMBER:
347005371
ADMINISTRATOR:MICLEA, DAVIDFACILITY TYPE:
740
ADDRESS:8445 OLD AUBURN ROADTELEPHONE:
(916) 242-0907
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 0DATE:
06/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:David Miclea, administratorTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Wolter arrived at the facility unannounced on 06/24/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain, LPA met with administrator, David Miclea and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and contacted facility and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Mask.

LPA and administrator toured facility together to ensure health and safety in the event of resident move in. Areas toured include but are not limited to: common areas, resident bedrooms, resident bathrooms, garage, and outdoor area. In the areas toured no immediate health, safety, or personal rights violations were observed.

LPA and administrator completed the infection control domain and facility was found to be in substantial compliance at this time. Administrator to let the department know when residents move in.

No deficiencies are being cited as a result of todays inspection.
Exit interview conducted and copy of report to be sent to administrator.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Danyle Wolter
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2021
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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