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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700556
Report Date: 03/19/2025
Date Signed: 03/19/2025 01:00:17 PM

Document Has Been Signed on 03/19/2025 01:00 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:DELA PAZ CARE HOMEFACILITY NUMBER:
342700556
ADMINISTRATOR/
DIRECTOR:		DELA PAZ, LOURDESFACILITY TYPE:
740
ADDRESS:6712 GREEN ASH CTTELEPHONE:
(916) 560-3232
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 4CENSUS: 2DATE:
03/19/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:Lourdes dela Paz, Administrator TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct an annual inspection. LPA met with Evie Sloan, staff and Edgardo Chico, staff, and explained purpose of inspection. Administrator, Lourdes dela Paz, and facility manager, Dennis Abadilla, arrived around 10:30 am. The facility is a level 7, vendorized by Alta California Regional Center, and is licensed for (4) non-ambulatory clients. LPA observed (2) clients in the home during the inspection and was advised (2) clients were attending day program. There are no clients currently under hospice care.

LPA and staff toured the interior/exterior of the facility including the common areas, (4) private resident bedrooms, staff room, (2) resident bathrooms, kitchen, office, laundry area and garage. LPA observed the facility to be clean, in good repair and odor-free. Bathrooms have the necessary grab bars, non-skid flooring or shower chair, paper towels, trash can with lids and 20-second hand-washing poster. There is sufficient 2+day perishable and 7+day non-perishable supply of food and sharps were locked in the kitchen. There are locked toxins in the laundry area and locked medications in the office. There are sufficient towels, linens/blankets/PPE/emergency supplies. The inside temperature measured 68*F and hot water measured 107*F in the kitchen. The fire extinguisher was last serviced on 8/16/24. Smoke/monoxide alarms are in working order. Resident rooms are very organized and decorated according to personal preference. There are (2) evacuation clipboards posted in the common areas that contain forms required for emergencies. There are (2) unlocked exit gates on the outside patio and covered patio seating. There is a very shallow pond that is fenced in the back yard.

LPA reviewed (2) of (4) client files. Files contain current individual/nursing care plans, physician's reports and other documentation. P&I funds were reviewed for (1) client- funds match documentation maintained. Medications were checked for (1) client. Orders match medications and documentation on file. (4) staff files were reviewed. Staff are completing initial/ongoing required training, including First Aid/CPR. RCFE Administrator Cert #7035764740 (exp 7/12/26). Discussed PIN 24-09 and age exception currently needed. LPA to provide additional information by email. LPA obtained current copy of liability insurance, LIC308 and LIC500. There were no deficiencies observed. Exit interview. Copy of report provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2025
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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