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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700203
Report Date: 11/09/2022
Date Signed: 11/09/2022 04:40:27 PM

Document Has Been Signed on 11/09/2022 04:40 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:PEOPLE'S CARE KEYESPORT WAYFACILITY NUMBER:
342700203
ADMINISTRATOR:AMANDA BRITTFACILITY TYPE:
735
ADDRESS:8317 KEYESPORT WAYTELEPHONE:
(909) 342-7163
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 4CENSUS: 4DATE:
11/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Stacey Takara, DSPTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection. LPA met with Stacey Takara, DSP, who contacted Administrator, Amanda Britt, by phone. Administrator stated she was unable to attend the inspection since she was at a related facility. LPA completed required COVID-19 testing protocols, applied hand sanitizer before entering the facility and wore the following Personal Protective Equipment (PPE) was worn: surgical mask. Additionally, LPA was screened by staff upon entering the facility. LPA observed (2) clients at the start of the inspection and observed (2) clients return towards the end of inspection from day program and from a shopping outing, along with DSP Elisha Peeler.

LPA and DSP Takara toured the interior and exterior of the facility including the common areas, (4) resident bedrooms (3) bathrooms, kitchen, laundry area and office area (converted garage). LPA observed the facility to be clean, in good repair and odor-free. LPA observed 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.. LPA observed locked sharps and medications in the office area. LPA observed the inside temperature to be 67*F. Fire extinguisher was last serviced 9/12/2022 and facility conducts quarterly fire drills. Discussed vaccination status of residents/staff- booster flyer provided. All staff have been N95 FIT tested and facility has sufficient PPE on hand. There is an outside gate that is able to be opened from the inside. Facility to do refresher staff training on how to wear PPE. LPA observed required postings throughout. LPA observed current ARF certificate #6061413735- exp 12/3/2023. LPA spoke to the Administrator by phone who authorized DSP Takara to sign today's report.

LPA requested an updated copy of LIC300 and LIC500 be provided by 11/19/22. There are no deficiencies issued today.
Exit interview. Copy of report provided to Administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2022
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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