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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700203
Report Date: 11/25/2024
Date Signed: 02/14/2025 01:19:14 PM

Document Has Been Signed on 02/14/2025 01:19 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:PEOPLE'S CARE KEYESPORT WAYFACILITY NUMBER:
342700203
ADMINISTRATOR/
DIRECTOR:
AMANDA BRITTFACILITY TYPE:
735
ADDRESS:8317 KEYESPORT WAYTELEPHONE:
(916) 735-5620
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 4CENSUS: 3DATE:
11/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Crystal Paulus, House Lead TIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection. LPA met with Crystal Paulus, Lead Staff, who contacted Administrator, Amanda Britt, by phone. Administrator stated she was unable to attend the inspection since she was at a related facility. Initially present was care staff, Brenda Salmon until 2:00 pm when she left and staff, Maliah Turner and Saron Weldon arrived for the "pm" shift. There are currently (3) clients in care. (1) client was out of the facility for a few months and his belongings were picked up by a family member on/around 10/23/24, as client moved to another care home. LPA observed (3) clients present during the inspection. Co-Administrator, Emily Mares, and Diane Mc Gill, Administrator from a related facility arrived at 2:15 pm to assist with the inspection.

LPA and Lead staff Crystal toured the interior/exterior of the facility including the common areas, (4) resident bedrooms (3) bathrooms, kitchen, laundry area and office area in the garage. LPA observed the facility to be clean, in good repair and odor-free, and the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and 20-second hand-washing posters. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food and locked toxins in the kitchen. Sharps and medications are secured in the office area. There are PPE, supplies and additional food in the garage. The inside temperature measured 74*F. Fire extinguisher was last serviced 9/12/24. Smoke/monoxide alarms work, and the facility conducts monthly fire drills. There are no pools.

(2) of (3) client files were reviewed and found to be organized and contain current documentation. Medications were reviewed for (1) client and P&I funds for another client. Orders match medications being administered and documentation is current with PRN letters on file. P&I records match funds on hand. (4) of (10) staff files were reviewed. All staff is cleared/associated and has current First Aid/CPR training as well as the required initial/ongoing training through an approved on-line vendor. Additional staff training is conducted monthly, as needed.


*cont on 809C-1..
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/25/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: PEOPLE'S CARE KEYESPORT WAY
FACILITY NUMBER: 342700203
VISIT DATE: 11/25/2024
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*809C-1... Administrator Amanda Britt has current ARF Certification # #7026888735- exp 12/3/2025. Administrator in training, Emily Mares has current ARF Certification #6072111735- exp 10/13/2026.

LPA observed required postings throughout.

LPA was provided with an updated copy of LIC500. Facility to submit a copy of LIC308 and copy of completed LIC610D (9 page version).

There are no citations issued; however, a Technical Violation is issued.

Exit interview. Copy of report provided to the Co-Administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
LIC809 (FAS) - (06/04)
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