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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700801
Report Date: 11/30/2021
Date Signed: 11/30/2021 01:34:53 PM

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: 5DATE:
11/30/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Vera Okyere, Licensee/AdministratorTIME COMPLETED:
11:45 AM
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On November 30, 2021, a Non-Compliance Conference was conducted on this day in the Sacramento North Regional Office via Microsoft Teams, due to COVID 19 precautions. The purpose of this Non-Compliance Conference meeting was to discuss the citations that has been issued in last year and complaint substantiated on October 7, 2021. Present in the meeting was Regional Manager (RM) Alycia Berryman, Licensing Program Manager (LPM) Laura Munoz, Licensing Program Analyst (LPA) Bethany Mirlohi, Licensing Program Analyst (LPA) Jacob Williams, and Administrator/Licensee Vera Okyere, The Non-Compliance Conference process was explained during this meeting to include the Administrative Process.

Facility has received four type A deficiencies for medication errors, record keeping, unlicensed care and three type B deficiency for unlicensed care, false claims and record keeping. On September 28, 2021, the Department received a complaint alleging the facility was operating outside of license terms and conditions and staff did not maintain records of centrally stored prescription medications. Control #25-AS-20210928131254

Issues discussed during the meeting were:
• Complaint filed against this facility
• Complaints filed against this facility (unlicensed care)
• Incidental Medical and Observation of Resident
• Incomplete records (medications errors)
• Food Service (insufficient two-days’ worth of perishable foods)
• False Claims (lying to licensing employees)
• Infection Control (not wearing a facemask when caring for clients)
• Administrator Qualifications and Duties/Accountability

**CONTINUED ON LIC809-C**
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Jacob WilliamsTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: MINNESOTA HOME CARE
FACILITY NUMBER: 342700801
VISIT DATE: 11/30/2021
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The Department would like the facility to submit the following by 12/10/2021:
  • Plan on how facility staff will be trained in required areas prior to completing duties. Plan should include - responsibility will be to conduct training, monitor training and document training.
  • Plan on how facility will monitor medication changes, storage, and administration to residents.
  • Statement describing how facility is ensuring staff are following facility's Mitigation Plan.

Completing the Non-Compliance Conference does not deprive the Department of its authority to take appropriate formal legal action under the Health and Safety Code if such action is deemed necessary by the Regional Manager.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiencies were cited during this visit. An exit interview was conducted with Administrator, Vera Okyere. A copy of this report was provided via email and an electronic email read receipt confirms receiving these documents. Administrator Vera Okyere will sign the document and send signed copy to LPA, Jacob Williams via email.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Jacob WilliamsTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021
LIC809 (FAS) - (06/04)
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