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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340312282
Report Date: 06/20/2023
Date Signed: 06/20/2023 01:42:48 PM

Document Has Been Signed on 06/20/2023 01:42 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:SEGOVIA'S CARE HOME #2FACILITY NUMBER:
340312282
ADMINISTRATOR:SEGVOIA, DANIELFACILITY TYPE:
735
ADDRESS:7931 OAK AVENUETELEPHONE:
(916) 722-6705
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 0DATE:
06/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Administrator, Nimfa SegoviaTIME COMPLETED:
01:50 PM
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Licensing Program Analyst (LPA) Angela Hood arrived at the facility on 6/20/23 to conduct a Required-1 Year Inspection utilizing the inspection tool.

LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are currently no residents residing at the care home. There are four bedrooms and two bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained.

LPA checked the kitchen area for the ability to prepare and store food. The facility has a locked cabinet that will be used for medications. Smoke detectors and carbon monoxide detector are operational. Fire extinguisher is maintained and ready for emergency use.

LPA reviewed two staff files. Facility emailed a current copy of certificate of liability insurance to LPA. Administrator has a current administrator certificate #6012199735 with an expiration date of 1/13/2024.

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: Angela Hood
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2023
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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