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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005861
Report Date: 08/22/2022
Date Signed: 08/22/2022 11:53:58 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/22/2022 11:53 AM - 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:GRANDMA'S HOME IIFACILITY NUMBER:
347005861
ADMINISTRATOR:MEHEDINTI, MIHAILFACILITY TYPE:
740
ADDRESS:6520 MILES LANETELEPHONE:
(916) 696-6542
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 4CENSUS: 3DATE:
08/22/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:MIHAIL MEHEDINTITIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Cassie Yang arrived unannounced to conduct a required annual. It should be noted: LPA was not able to select Required 1 Year Annual option. LPA met with Mihail Mehedinti, Licensee, and explained purpose of inspection. Before today's inspection, LPA completed required COVID-19 testing protocols and completed daily assessment and confirmed the facility does not currently have any positive Covid-19 diagnoses. LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. The facility currently has (3) residents and (0) residents on hospice services.

LPA and Licensee toured the interior and exterior of the facility including staff room, bathrooms, bedrooms, laundry room, kitchen and common area. In areas toured, LPA observed the facility to be clean, safe and in good repair and to not pose a health and safety risk or personal rights violation. LPA observed paper towels, soap and sanitizer in restrooms. LPA advised Licensee to have all trash can with lids. LPA advised Licensee to have handwashing signs in the bathroom. Inside temperature was observed to be 77* F. LPA observed sharps, toxics and medication to be locked and secured. LPA observed the facility to have 2+ days of perishables and 7+ days of non-perishables. Licensee informed LPA he will be going on a 1 month vacation to Europe and will re-submit LIC 308 to LPA. LPA observed Administrator Certificate #6015325740 expired 5/28/2022. Licensee provided proof of renewal to LPA. LPA observed Licensee to be playing the guitar to residents.

LPA requested an updated copy current liability insurance during today's inspection by 8/31/2022.

There were no deficiencies observed during today's inspection.

Exit interview. Copy of report left at facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2022
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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