<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700070
Report Date: 11/05/2024
Date Signed: 11/05/2024 03:55:49 PM

Document Has Been Signed on 11/05/2024 03:55 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:KIND CONNECTIONFACILITY NUMBER:
342700070
ADMINISTRATOR/
DIRECTOR:
DELA PAZ, MA. LOURDESFACILITY TYPE:
740
ADDRESS:8159 WACHTEL WAYTELEPHONE:
(916) 599-0477
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
11/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Lourdes de la Paz, Administrator TIME VISIT/
INSPECTION COMPLETED:
03:55 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct an annual inspection and met with Lourdes de la Paz, Administrator, and stated the reason for today's inspection. Also present was caregiver, Richard Dumol. The facility is a specialized RCFE facility vendorized through Alta California Regional Center, licensed for (4) non-ambulatory residents, (2) of whom can be bedridden. There are currently (4) residents. At the start of the inspection, (1) client was present. (3) clients returned from day program during the inspection.

LPA and the Administrator toured the interior/exterior of the facility including the common areas, (4) resident bedrooms (2.5) bathrooms, kitchen, activity room, staff room, laundry area and garage. The facility was clean, organized, in good repair and odor-free. The bathrooms have the necessary grab bars, non-skid flooring, paper towels and 20-second hand-washing posters. There is sufficient 2+day perishable and 7+day non-perishable food. Each resident room door has a locking mechanism, per Title 17, and there are alarms on each exit door. There is a music therapist and recreational therapist that visit weekly. (3) clients currently attend day program. The smoke/monoxide alarms are in working order, and the fire extinguisher was last serviced 7/19/24, Toxins are locked in the kitchen and laundry area. Medications sharps are locked in the kitchen. The inside temperature measured 70*F, and the hot water temperature measured 106*F in a resident bathroom. There is one unlocked exit gate and sufficient outside seating with shade and a garden. All required posters are visible in the common area. There is a complete First Aid kit.

LPA reviewed (2) of (4) client files and found them to be organized, complete and current. Medications were checked for (1) client- orders matched medications being given and documentation is current. P&I was confirmed for (2) residents. There is also a current surety bond- exp 4/26/25. (4) staff files were reviewed- documentation on file for initial and/or ongoing training, including current First Aid/CPR certifications. Administrator RCFE Certificate #7035764740- exp 7/12/26. Updated copy of liability insurance obtained. There are no deficiencies. Copy of report provided to the Administrator.
Maribeth SentyTELEPHONE: (916) 263-4813
Sabrina CalzadaTELEPHONE: (510) 829-2133
DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
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 1