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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700801
Report Date: 04/05/2022
Date Signed: 04/05/2022 11:55:54 AM

Document Has Been Signed on 04/05/2022 11:55 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
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: 6DATE:
04/05/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:21 AM
MET WITH:Vera OkyereTIME COMPLETED:
12:11 PM
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On 04/05/2022, Licensing Program Analyst (LPA) Williams arrived unannounced to conduct a case management visit regarding the legal action pending against Minnesota Home Care. LPA met with Administrator/Licensee Vera Okyere. Prior to entering, LPA completed weekly COVID testing, daily symptom screening, used hand sanitizer and wore surgical mask.

LPA viewed notice posted at entry of hallway (conspicuous location) stating "Notice of Action Pending". LPA asked to see notice that was provided to residents, and Licensee presented a printed copy of the notice that is addressed to the residents containing all of the required components and dated 03/28/2022. LPA asked to see the letter addressed to LTCO and Licensee presented a copy containing all the necessary components. LPA asked if Licensee notified the residents responsible parties, to which Licensee stated she had. LPA took down responsible parties respective phone numbers and will verify that they have been notified later today (04/05).

There are no citations being assessed during visit. Exit interview conducted and a copy of report will be left at facility.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Jacob Williams
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2022
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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