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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340312629
Report Date: 01/17/2024
Date Signed: 01/17/2024 11:22:06 AM

Document Has Been Signed on 01/17/2024 11:22 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:NAVARRO RESIDENTIAL CAREFACILITY NUMBER:
340312629
ADMINISTRATOR:NAVARRO, ANGELFACILITY TYPE:
740
ADDRESS:7327 SOVEREIGN COURTTELEPHONE:
(916) 502-7140
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY: 6CENSUS: 4DATE:
01/17/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee, Lito Navarro TIME COMPLETED:
11:30 AM
NARRATIVE
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On 01/17/24 at 10am, an informal conference was conducted at the Sacramento Regional office. The purpose of this informal conference meeting is to discuss the citations regarding medication errors that has occurred in the last two years. Present in the meeting is Regional Manager (RM) Alycia Berryman, Licensing Program Manager (LPM) Laura Munoz, LPM Troy Ordonez , Licensing Program Analysts (LPA) Talwinder Bains and Cassie Yang, ALTA Regional staff, Christina Lane, Jazmin Kung-Gunion, Vanessa Logsdon and facility’s licensee/administrator, Lito Navarro.

The informal conference process was explained during this meeting.

A review of the facility's history within the last two years was discussed.

Issues discussed during the meeting were:
• Medication Management/Errors
• Incidents Reporting

The facility has stated they will do the following to achieve continued and substantial compliance:
: Incorporate outside sources and alternatives for medication management and audits
: Maintain an internal audit for reporting of incidents.
: Reach out to Community Care Licensing Division (CCLD) as a resource.

The Department will be referring this facility to the Technical Support Program.
During today's meeting , deficiencies are cited pursuant to California Code of Regulations, Title 22 and documented on the attached LIC809D. Exit interview conducted and appeal rights provided.
Informal meeting concluded and a copy of report was given.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 01/17/2024 11:22 AM - It Cannot Be Edited


Created By: Talwinder Bains On 01/17/2024 at 10:27 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: NAVARRO RESIDENTIAL CARE
FACILITY NUMBER: 340312629

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/18/2024
Section Cited

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80075 Health Related Services
(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.

This requirement is not as evidenced by:
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Based on the FAR investigations issued by ALTA California Regional Center, the facility did not assist residents in care with medications as prescribed which posses an immediate health and safety risk to residents in care.
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Civil penalty was issued today because of repeat violation within last 12 months .
Type B
02/17/2024
Section Cited

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87405(d)(2)- Administrator - Qualifications and Duties-The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply....This requirement is not as evidenced by:
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Based on records review and interviews, it has been concluded that facility does not have qualify administrator which poses a potential risk to residents in care for thier health and safety.
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Civil penalty shall be assessed if POC requiements are not met by POC date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Laura Munoz
LICENSING EVALUATOR NAME:Talwinder Bains
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2024


LIC809 (FAS) - (06/04)
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