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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700690
Report Date: 10/24/2024
Date Signed: 10/24/2024 02:04:00 PM

Document Has Been Signed on 10/24/2024 02:04 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:CROSSPOINT RESIDENTIALFACILITY NUMBER:
342700690
ADMINISTRATOR/
DIRECTOR:
OGENAH, OGIATOR MICHAELFACILITY TYPE:
735
ADDRESS:7504 MOUNTAIN OAK WAYTELEPHONE:
(916) 333-1004
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY: 6CENSUS: 6DATE:
10/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Edirin Osah, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:25 PM
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On October 24, 2024, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to conduct an annual inspection. LPA met with Administrator, Edirin Osah
and informed her the reason for the visit. Administrator's Certificate expires 6/18/2026 . The facilities temperature was 77 degrees F. The facility's sketch, resident's rights, emergency disaster plan and Administrator's Certificate was available for viewing. The current census is 6.

LPA conducted a walk-through of the facility to ensure compliance with Title 22 regulations. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms and kitchen. In the kitchen area, cabinets and drawers were reviewed. Knives and sharp objects were reviewed to make sure that they were locked and made inaccessible to the residents at all times. LPA observed there to be a sufficient amount of 2-day perishable and 7-day non-perishable food. Hot water temperatures were taken and measured at 108 degrees F.

Furniture and furnishings were observed to be sufficient. Resident bedrooms and bathrooms were toured. All rooms had the required items of furniture. In the bathrooms, the sink, toilet, bathtub and shower operate properly. The facility has a sufficient supply of linens, towels, bedding, etc. for residents in care. Washer and dryer was present and operating properly. Toxic substances, laundry and cleaning supplies were inaccessible.

To continue see 809-C...

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2024
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: CROSSPOINT RESIDENTIAL
FACILITY NUMBER: 342700690
VISIT DATE: 10/24/2024
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First aid kit was present and complete. Fire alarms, smoke alarms, and carbon monoxide detectors operate properly. Fire extinguisher is maintained and ready for emergency use.

LPA inspected the exterior grounds of this facility. There are no bodies of water on the premises. The perimeter fence, side gates, and latches were in good repair. There’s a cabinet for resident’s medication. Medication cabinet was locked. The facility Medication Administration Record was reviewed as well as the dispensing log. All were current and complete.

LPA reviewed 2 resident files and 2 staff files. Resident's Records reviewed indicated Emergency Contacts, Assessments, Admission Agreements and Physician's Reports were all current and up to date. Staff records reviewed revealed current First Aid & CPR certificates, Health Screenings and Emergency Contacts were all up to date. The facility is conducting staff training as required.



No Deficiencies cited.

Exit interview conducted. Copy of this report given.


The administrator shall submit updated copies of the LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610D the Emergency Disaster Plan, and copy of current Liability Insurance to update the facility file in our Regional Office . Administrator shall submit the listed documents to Licensing no later than November 24, 2024.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC809 (FAS) - (06/04)
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