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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700801
Report Date: 12/06/2023
Date Signed: 12/06/2023 03:51:43 PM


Document Has Been Signed on 12/06/2023 03:51 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:
12/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Vera Okyere, Administrator TIME COMPLETED:
03:55 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required quarterly case management inspection and annual inspection. LPA met with Vera Okyere, Administrator, and explained purpose of inspection. Also present was Annastaycia Kelly, caregiver.

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 September, October, November 2023. Some training has also been started for December 2023. Training topics varied each month. Postural Supports and Dementia related topics were discussed in September 2023. Restricted health conditions were discussed in October 2023 and Postural Supports and Psychosocial needs of the elderly in November 2023. In December 2023, staff received training on hospice and nutrition and exercise.

As part of the annual inspection, 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.

Medications, including orders and documentation, were reviewed for (2) residents during today's annual. The facility is maintaining complete records and obtains current orders for residents at each doctor's visit.

LPA advised the Department will conduct a subsequent quarterly visit on/around March 2024.
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: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2023
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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