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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700231
Report Date: 10/20/2023
Date Signed: 12/22/2023 04:02:13 PM


Document Has Been Signed on 12/22/2023 04:02 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:ANA'S LOVING HOME CAREFACILITY NUMBER:
342700231
ADMINISTRATOR:CAI, ANA, MARIAFACILITY TYPE:
740
ADDRESS:7544 SOQUEL WAYTELEPHONE:
(916) 722-7300
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 6DATE:
10/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Ana Maria Cai, AdministratorTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met with caregiver,Deidre King, who contacted Ana Maria Cai, Administrator, who arrived at approximately 1:45 pm. Elena Morariu, caregiver, arrived with Administrator. LPA observed (4) residents eating lunch in the common area and (2) residents in their rooms at the start of the inspection. The facility is licensed for (5) non-ambulatory residents, (1) bedridden and has a hospice waiver for (2). Currently, there are (0) residents on hospice.

LPA and the Administrator toured the interior and exterior of the facility including the common areas, resident bedrooms (5), resident bathrooms (3), kitchen, staff room and laundry area. 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 hand-washing posters. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps and medications in the kitchen. LPA observed toxins to be secured in the laundry room nearby. Inside temperature read 77*F and the hot water temperature measured 120*F in a resident bathroom. Fire extinguisher last serviced 8/14/23 and smoke/monoxide alarms are in working order. Facility conducts quarterly fire drills. LPA reviewed the Infection Control Plan (LIC9282) and found it to be complete. LPA observed (1) unlocked gate from the inside back patio. There are no bodies of water/pool. LPA observed sufficient incontinent products/PPE and linens/towels/blankets. LPA reviewed (3) resident files and observed them to be complete, organized and contain current documentation. Medications were reviewed for (2) residents and no discrepancies were found. (3) staff training records were reviewed. All staff have current First Aid/CPR and have recently completed initial or ongoing training. Administrator has an active RCFE Certification #6041800740-(exp 9/5/24) and is waiting to receive an updated copy. An updated copy of LIC500, LIC308 to be provided to the Department by 10/27/23. There are no deficiencies issued during today's inspection.

Exit interview with Administrator. Copy of report provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/20/2023
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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