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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005371
Report Date: 07/15/2022
Date Signed: 07/15/2022 03:56:29 PM

Document Has Been Signed on 07/15/2022 03:56 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:
07/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:57 PM
MET WITH:David Miclea, LicenseeTIME COMPLETED:
02:55 PM
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Licensing Program Analyst (LPA) Jacob Williams arrived at the facility unannounced on 07/15/2022 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: surgical Mask.

Administrator explained there are no residents residing in the facility. 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: Anthony Perez
LICENSING EVALUATOR NAME: Jacob Williams
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2022
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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