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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700801
Report Date: 03/26/2024
Date Signed: 03/26/2024 03:52:42 PM


Document Has Been Signed on 03/26/2024 03:52 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: 5DATE:
03/26/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:15 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 case management inspection to follow up on recent hospitalization stays for resident (R1). LPA met with Vera Okyere, Administrator, and explained purpose of inspection. Also present was Enock Yartey, caregiver.

LPA observed (2) residents 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 (5) residents and (1) resident is on hospice.

LPA and Administrator discussed the recent hospitalization stays for resident (R1), beginning on/around December 2023 with the last stay ending on 3/20/24. LPA reviewed discharge paperwork which noted resident was prescribed an antibiotic and has a follow up phone appointment on 3/27/24 with his physician. Additionally, (R1) will be receiving home health services for a 2-3 weeks to provide additional care and support. An updated physician's report was obtained on 3/14/24. Administrator will update the care plan to include home health plans. Administrator noted there have been no changes in the level or type of care and resident remains independent.

While the Administrator was present, (R1) told LPA he remained in the hospital for a longer period due to being poisoned from the medication the hospital gave him. The Administrator stated the hospital was giving resident the medication, Lithium, three time daily and now the dosage has been lowered to once daily, in the evening only. (R1) stated he has a wound that hasn't healed well and confirmed he will be receiving services from home health. (R1) stated he is eating well now and is happy to be back at the community.

LPA reviewed paperwork for (R1) and obtained copies of hospital discharge paperwork. Several incidents reports were submitted during the time frame reviewed.
There are no deficiencies cited on 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: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/26/2024
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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