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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700111
Report Date: 02/13/2025
Date Signed: 02/13/2025 04:14:01 PM

Document Has Been Signed on 02/13/2025 04:14 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:DELICATE STEMS FOR THE ELDERLYFACILITY NUMBER:
342700111
ADMINISTRATOR/
DIRECTOR:
LAURA DOXANFACILITY TYPE:
740
ADDRESS:7008 HERSHBERGER COURTTELEPHONE:
(916) 370-2417
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 5TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
02/13/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Laura Doxan, Administrator TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection and met with Laura Doxan, Administrator, stating the reason for today's inspection. Also present was caregiver, Allet Levy. LPA observed (1) resident in the common area and (2) residents resting in their rooms. There is an approved hospice waiver for (4) residents. Currently there is (1) resident on hospice.

LPA and Administrator toured the interior and exterior of the facility including the common areas, (3) resident bedrooms, (2) full bathrooms, kitchen, office, staff room, and locked laundry area/garage. LPA observed the facility to be clean, in good repair and odor free. LPA observed the bathrooms to have the necessary grab bars, shower chair, paper towels, soap and trash can. There is sufficient 2+day perishable, including fresh produce, and 7+day non-perishable supply of food. The refrigerator temperature measured 39*F and the freezer measured 0*F. Sharps are locked in the kitchen and toxins are secured in the laundry room. A lock will be installed in the kitchen so toxins can be stored. Hygiene/nail polish is also locked. Medications are secured nearby. Fire extinguisher was last serviced 9/3/24 and the smoke monoxide alarms are functional. There is a complete First Aid kit and sufficient linens/towels/blankets/PPE supplies. There is an auditory alert device on each exit door. The inside temperature measured 71*F, and the hot water measured in 105*F in the kitchen. There is one unlocked exit gate outside. There are no pools.

LPA reviewed (3) of (3) resident binders. Files were organized and contained current documentation. Medications were reviewed for (1) resident-there were no discrepancies noted. LPA reviewed (6) staff files. All staff is cleared/associated and has completed the required current training, including First Aid/CPR. LPA and the Administrator reviewed the Plan of Operation/Dementia Care Plan to ensure it reflects the updated regulations (effec 1/1/25). Discussed updates to some information on the Admission Agreement.

LPA obtained an updated copy of current liability insurance, and requested LIC500 and LIC308 be submitted to the Department by 2/20/25.
Exit interview with Administrator. Copy of report provided.
Maribeth SentyTELEPHONE: (916) 263-4813
Sabrina CalzadaTELEPHONE: (510) 829-2133
DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025
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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