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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002878
Report Date: 03/07/2024
Date Signed: 03/07/2024 01:30:19 PM


Document Has Been Signed on 03/07/2024 01:30 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: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:
03/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Carmen Ion, AdministratorTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met with caregivers, Taneshea Terry and Damali John and stated the reason for the inspection. Administrator, Carmen Ion, arrived at approximately 11:00 am. LPA observed (1) resident to be in the common area and (4) residents to be in their rooms at the start of the inspection. There are (2) residents currently under hospice care.

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 sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps and toxins in the kitchen and locked medications nearby. Inside temperature measured 76*F and hot water measured 114*F in the kitchen. The fire extinguisher was last serviced on 3/21/2023 and the smoke/monoxide alarms work. Quarterly emergency drills are being conducted. There are sufficient towels, linens, incontinent products and PPE. First Aid kit is complete. There are activities/games on site with sufficient indoor/outdoor space. There is (1) unlocked exit gate and patio seating. All required postings are in the common area. RCFE Administrator certificate # 6034379740- exp 4/27/25.

(3) resident files were reviewed and found to be organized and contain current documentation, including care plans/physician's reports. Medications were reviewed for (3) residents- orders matched medications being administered and documentation is complete. (6) staff files were reviewed and found to be complete, organized and contain current training documentation, including First Aid/CPR. Infection Control Plan was reviewed/approved. Emergency Disaster Plan was reviewed and is posted.
Obtained copy of current liability insurance and LIC500. LIC308 to be provided by 3/14/24.
There were no deficiencies observed but a Technical Advisory note is issued.
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: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2024
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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