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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700801
Report Date: 05/30/2023
Date Signed: 05/30/2023 11:51:58 AM


Document Has Been Signed on 05/30/2023 11:51 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
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



FACILITY NAME:MINNESOTA HOME CAREFACILITY NUMBER:
342700801
ADMINISTRATOR:OKYERE, VERA A.FACILITY TYPE:
740
ADDRESS:7448 MINNESOTA DR.TELEPHONE:
(916) 729-9461
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 4DATE:
05/30/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Vera Okyere, Administrator TIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required quarterly case management inspection. LPA met with Vera Okyere, Administrator, and explained purpose of inspection. LPA observed (1) resident to be in the common area and (3) residents to be in their rooms at the start of the inspection. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (4). Currently, there are (0) residents on hospice.

LPA reviewed the binder with documentation of monthly training for all (3) staff to have been completed for February, March, April and May 2023. Training topics varied each month. Administrator confirmed specific medication training was conducted twice in February 2023, and once in March, April and May 2023.
LPA observed documentation of N95 Fit Testing to have been completed on 5/8/23 for Administrator and (1) new staff, Stephen.

LPA and Administrator toured the inside areas of the facility including kitchen, bathroom, resident rooms, laundry area and staff rooms. LPA observed all areas to be clean and in good repair. LPA observed toxins, medications and sharps to be locked separately in the kitchen and laundry area and an electric hand-dryer to have been installed in one resident bathroom as Administrator previously agreed to.

Administrator indicated she has already completed (20) hours towards her Administrator recertification, due in August 2023. LPA observed sufficient PPE and food supplies on site.

LPA advised the Department will conduct a subsequent quarterly visit on/around August 2023.

There are no deficiencies cited in this report.

Exit interview. Copy of report provided to Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/30/2023
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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