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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340312282
Report Date: 07/18/2024
Date Signed: 07/18/2024 11:17:24 AM

Document Has Been Signed on 07/18/2024 11:17 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SEGOVIA'S CARE HOME #2FACILITY NUMBER:
340312282
ADMINISTRATOR/
DIRECTOR:		SEGVOIA, DANIELFACILITY TYPE:
735
ADDRESS:7931 OAK AVENUETELEPHONE:
(916) 223-5315
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 0DATE:
07/18/2024
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Daniel Segovia, Administrator TIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived for a scheduled required annual inspection at 10:30 am. The annual was scheduled due to there not being any residents currently living at the care home. LPA contacted Nimfa Segovia, Assistant Administrator at 10:40 am and was advised there was a family emergency and she could not attend the annual but the Administrator, Daniel Segovia, would be at the care home shortly. Administrator, Daniel Segovia, arrived at approximately 11:00 am.

LPA and Administrator conducted a tour inside the home and observed there were no residents present. There are (4) resident bedrooms and (2) resident bathrooms for when the care home is operational again. Bathrooms have the necessary grab bars and non-skid flooring and resident bedrooms have furniture.

The kitchen has a locked drawer for sharps. Medications will be secured in a locked cabinet next to the kitchen. Toxins will be secured in the garage.

The fire extinguisher was last serviced on 1/8/24, and the smoke/monoxide alarms are operational.

There were a few postings in the common areas. Annual fees are current.

The Administrator was advised to notify the Department when the care home becomes operational again. The Administrator maintains communications with the Regional Center.

There are no deficiencies issued in this report.

Exit interview. Copy of report provided to the Administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2024
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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