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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700801
Report Date: 12/17/2020
Date Signed: 12/17/2020 12:36:02 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:MINNESOTA HOME CAREFACILITY NUMBER:
342700801
ADMINISTRATOR:OKVERE, VERA A.FACILITY TYPE:
740
ADDRESS:7448 MINNESOTA DR.TELEPHONE:
(916) 729-9461
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 5DATE:
12/17/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Vera Okvere, AdministratorTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Bethany Huusfeldt arrived announced to complete a pre-licensing inspection. LPA met with Administrator Vera Okvere via facetime. Currently there are 5 residents residing within the facility. Fire clearance was granted on 11/16/20 for 6 non-ambulatory residents.

Facility was inspected both indoors and outdoors. LPA inspected 5 resident bedrooms, 2 bathrooms, 1 staff room, common living areas, kitchen, and laundry room. Outdoor area is free from hazardous debris. LPA observed covered seating area in the backyard. Outdoor exits are clear and accessible. First aid kit was found to be complete. Centrally stored medications will be stored in kitchen area in a locked cabinet. The facility has adequate lighting throughout. LPA inspected 5 resident bedrooms and the bedroom had appropriate furnishings, chair, adequate lighting and storage. Bathrooms are clean, sanitary, and in good repair. Smoke detectors and carbon monoxide detectors were checked and operational. Fire extinguisher indicator revealed a full charge. Kitchen is clean, sanitary, and in good repair. The kitchen has operable appliances. There is a locked area for cleaning supplies and toxins in the laundry room area. LPA observed 2 day perishable and 7 day non-perishable foods available in the home. Water temperature was measured at 110 degrees. A working telephone is available.

LPA observed the resident rights, licensing complaint poster, and rights to council were not posted. Administrator to post signs and follow up pre-licensing will be scheduled.
Component III was completed on 12/17/20.

Exit Interview conducted. Copy of reports were emailed to licensee/administrator.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany HuusfeldtTELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2020
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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