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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002886
Report Date: 02/10/2023
Date Signed: 02/10/2023 01:54:24 PM


Document Has Been Signed on 02/10/2023 01:54 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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:CITRUS CREST CARE HOME 1FACILITY NUMBER:
345002886
ADMINISTRATOR:CHAVEZ, ANGELICAFACILITY TYPE:
740
ADDRESS:6906 HENNING DRIVETELEPHONE:
(916) 728-1338
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:6CENSUS: 2DATE:
02/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Admininstrator- Muamoudou Aidara Soumahoro TIME COMPLETED:
02:05 PM
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Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced on 02/10/2023 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with facility staff, Rose Ruth Tumukunde, and explained the purpose of the visit. LPA requested for staff to notify Administrator, Muamoudou Aidara Soumahoro, of LPA's presence at the facility. LPA wore the following Personal Protective Equipment (PPE) during today's visit: surgical mask. LPA were screened by facility staff before entry to facility.

LPA and staff toured facility together to ensure the health and safety of residents in care. Areas toured include but are not limited to: kitchen, common areas, four (4) bedrooms, two (2) bathrooms, medication cabinet, garage, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. At 1:43 PM, Administrator arrived at the facility. LPA and Administrator completed the infection control domain together and facility was found to be in substantial compliance at this time. LPA provided ED summary of PIN 23-02-ASC - UPDATED GUIDANCE ON TESTING, ISOLATION AND QUARANTINE.

No deficiencies are being cited as a result of today's inspection.

Exit interview conducted and copy of report left at the facility.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2023
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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