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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700694
Report Date: 12/11/2024
Date Signed: 12/11/2024 12:34:22 PM

Document Has Been Signed on 12/11/2024 12:34 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:BROOKHAVEN HOME CAREFACILITY NUMBER:
342700694
ADMINISTRATOR/
DIRECTOR:
ARTAN, ADELA CLAUDIAFACILITY TYPE:
740
ADDRESS:5916 SHADOW OAK DRIVETELEPHONE:
(916) 903-7688
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
12/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Administrator- Adela ArtanTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
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On 12/11/24 Licensing Program Analysts (LPAs) Cheyenne Ratajczak and Graham Gunby arrived at the facility unannounced to conduct a Required 1 Year annual inspection. LPAs met with Administrator, Adela Artan and explained the purpose of the visit.

LPAs and Administrator toured the interior and exterior of the facility. Areas toured include but not limited to the kitchen, resident bedrooms, bathrooms, common areas and backyard. LPAs observed sufficient furniture and lighting throughout the facility. LPAs observed there is sufficient food supplies for seven (7) day non-perishable and two (2) day perishable. LPAs observed toxins and knives to be locked and inaccessible to residents in care. LPAs also observed centrally stored medications are kept locked and inaccessible to residents. The fire extinguisher located in the kitchedn was last inspected on 08/30/24. Smoke detectors are current and in compliance with fire safety including carbon monoxide detector. LPAs reviewed drill logs, which are conducted monthly.

LPAs reviewed four (4) resident files and two (2) staff files all files contained the required documents.

LPA Ratajczak requested Administrator to send updated copies of the following by 12/13/24 to LPA
  • LIC308- Designation of Administrative Responsibility
  • Liability insurance
  • LIC500- Personnel Report

No deficiencies being cited during today's inspection.

Exit interview conducted and report provided
Laura MunozTELEPHONE: (916) 263-4743
Cheyenne RatajczakTELEPHONE: (916) 969-7879
DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
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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