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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700801
Report Date: 08/25/2023
Date Signed: 08/25/2023 04:18:36 PM


Document Has Been Signed on 08/25/2023 04:18 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: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:
08/25/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Vera Okyere, Administrator TIME COMPLETED:
04:25 PM
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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 (4) residents and (1) resident is on hospice.

LPA reviewed the binder with documentation of monthly training for all (3) staff to have been completed for June, July and August 2023. Training topics varied each month. Nutrition and Exercise were discussed in June and July along with different aspects of medication administration, including documentation, responsibilities with handling medications and terminology. Hospice care was discussed in August.

LPA to email a copy of the Medication Guide for RCFE's for an additional resource to use for staff training.

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.

LPA observed sufficient food supplies on site, including fresh produce.

LPA advised the Department will conduct a subsequent quarterly visit on/around November 2023. LPA and Administrator discussed a separate matter previously discussed involving reimbursement for a resident who no longer lives at the facility. Administrator to make the necessary contact next week.

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: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2023
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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