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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002892
Report Date: 05/10/2023
Date Signed: 05/10/2023 12:01:34 PM

Document Has Been Signed on 05/10/2023 12:01 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:BLESSINGS CARE HOMEFACILITY NUMBER:
345002892
ADMINISTRATOR:STEWART, JEFFREYFACILITY TYPE:
735
ADDRESS:7733 GINGERBLOSSOM DRTELEPHONE:
(707) 704-0357
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY: 6CENSUS: 5DATE:
05/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Administrator: Jeffrey Stewart TIME COMPLETED:
12:30 PM
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On 05/10/2023 at 9:40 AM, Licensing Program Analysts (LPAs) Sarena Keosavang and Michael Hood arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA request for staff to call and notify Administrator of LPAs presence at the facility. LPA met with Administrator, Jeffrey Stewart, and explained the purpose of the visit.

At 9:56 AM, LPAs reviewed a total of five (5) resident files. Resident files contain signed admission agreements, physician's reports, appraisals, and resident's rights. Medications are centrally stored, locked, and appear to be given per doctor order. LPAs compared medications to those being given for two (2) residents and found no discrepancies. Facility is correctly using the Medication Administration Records (MAR). LPA reviewed a total of one (1) staff record. Staff has training in medications, first aid and CPR, and other various areas of care provision.

At 10:50 AM, LPAs and administrator toured the interior and exterior of the facility to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, residents' bedrooms, bathrooms, kitchen, laundry room, garage and backyard. LPAs observed required furniture, and lighting throughout the residents' bedrooms and facility. LPAs observed residents' bathrooms to be clean, sanitary, and in good repair. LPAs observed food supplies of non-perishables for a minimum of one (1) week and perishable foods for a minimum of two (2) days. Toxic and cleaning supplies locked and is inaccessible to residents in care. The hot water temperature was measured in the kitchen at 113 degrees Fahrenheit. First aid kit was completed. LPAs observed fire detectors and carbon monoxide alarms to be operable. The fire extinguisher was last serviced on 04/25/2023. Fire drills are conducted first of the month. LPAs observed medications to be locked and inaccessible to residents in care. LPAs observed required Licensing posters posted throughout the facility.

No deficiencies being cited during today's inspection.

Exit interview conducted and report provided.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Sarena Keosavang
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2023
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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