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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002878
Report Date: 02/23/2023
Date Signed: 02/23/2023 04:48:18 PM


Document Has Been Signed on 02/23/2023 04:48 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:CARMEN ELDERLY CAREFACILITY NUMBER:
345002878
ADMINISTRATOR:ION, CARMENFACILITY TYPE:
740
ADDRESS:7548 ALMONDWOOD AVETELEPHONE:
(916) 673-6607
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:5CENSUS: 5DATE:
02/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Carmen Ion, Administrator TIME COMPLETED:
04:50 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met with Carmen Ion, Administrator, and explained purpose of inspection. LPA observed (1) resident in the common area and (4) residents in their rooms at the start of the inspection. In addition, LPA observed (2) hospice nurses present with (2) residents receiving hospice services. The facility is licensed for (5) non-ambulatory residents and has a hospice waiver for (2). Prior to initiating today's inspection, LPA completed required COVID-19 Department protocols, wore a surgical mask and was screened per Covid-19 precautionary measures upon entering the facility.

LPA and Administrator toured the interior and exterior of the facility including the common areas, (1) private resident bedroom, (2) shared resident bedrooms, (2) resident bathrooms with showers, kitchen, office and garage/laundry area. LPA observed the facility to be clean, in good repair and odor-free. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps and toxins in the kitchen and locked medications nearby. LPA observed the inside temperature to be 75*F. The fire extinguisher was last serviced on 3/30/22. Discussed vaccination status of residents/staff and eligibility for boosters. Booster flyer provided. LPA observed multiple Covid posters throughout as well as other required postings. RCFE Administrator certificate #6034379740- exp 3/16/23 posted- renewal is pending. LPA observed (1) unlocked gate from the inside back patio and outdoor seating with shade. LPA observed sufficient incontinent, paper and PPE products on hand. Administrator to post a "mask required " sign near the front entrance. . LPA and Administrator completed the Infection Control Domain of the tool.

LPA obtained an updated copy of the LIC500 and current liability insurance during today's inspection.

There are no deficiencies issued during today's inspection. Exit interview. Copy of report provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2023
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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