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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005371
Report Date: 04/15/2024
Date Signed: 04/15/2024 12:08:35 PM

Document Has Been Signed on 04/15/2024 12:08 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:AAA CAREFACILITY NUMBER:
347005371
ADMINISTRATOR/
DIRECTOR:		MICLEA, DAVIDFACILITY TYPE:
740
ADDRESS:8445 OLD AUBURN ROADTELEPHONE:
(916) 242-0907
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 0DATE:
04/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:10 AM
MET WITH:David Miclea, Administrator TIME VISIT/
INSPECTION COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived announced to conduct a required annual and met with David Miclea, Administrator. There are no residents in care currently, and the facility has not operated since 2020.

LPA and Administrator the interior and exterior of the facility including the common areas, (2) private resident bedrooms (2) shared resident bedroom, (2) resident bathrooms, (1) staff room in the staff area, office, kitchen, laundry/garage area. LPA observed all required postings to still be posted and the fire extinguisher to have been serviced last 12/27/23. Smoke/monoxide alarms are in working order. LPA observed the facility to be clean, in good repair and odor-free. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring. There is a locked drawer for sharps and a locked cabinet for medications in the kitchen are. Toxins are locked in the laundry area. There is a sufficient supply of linens/towels/blankets/PPE on site. There are indoor activities/board games on site.

There is a lot of backyard space with seating and an umbrella. There is (1) unlocked gate from the inside of the backyard and a locked entrance gate from the outside near the curb. There is a functioning land phone line. LPA observed the liability insurance to be current. LPA observed the hot water temperature in a bathroom to measure 112*F. LPA observed a complete First Aid Kit.

Administrator certificate #6023721740- current through 1/27/25. LPA provided updated copy of LIC610E and LIC9282. Discussed the Department's website and how forms can be accessed. Also discussed Guardian. Administrator is receiving the Provider Informational Notifications (PIN). Email on record is current. Annual fees are current. Administrator will notify the Department when the facility accepts a first resident and resumes operation.

As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit interview conducted and copy of report given at the conclusion of this visit.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/15/2024
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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