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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002892
Report Date: 10/16/2024
Date Signed: 10/16/2024 09:34:30 AM

Document Has Been Signed on 10/16/2024 09:34 AM - 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:BLESSINGS CARE HOMEFACILITY NUMBER:
345002892
ADMINISTRATOR/
DIRECTOR:		STEWART, JEFFREYFACILITY TYPE:
735
ADDRESS:7733 GINGERBLOSSOM DRTELEPHONE:
(707) 704-0357
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY: 6CENSUS: 6DATE:
10/16/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Staff-Karen MutukuTIME VISIT/
INSPECTION COMPLETED:
09:40 AM
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On 10/16/24 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived unannounced to conduct a case management health and safety visit. LPA met with Staff-Karen Mutuku and explained the purpose of the visit. LPA requested for staff to notify Administrator, Jeffrey Stewart of LPA's presence at the facility. Administrator was unable to meet at the facility and gave staff permission to assist LPA during today's visit.

During time of visit six (6) resident were present at the facility. LPA observed there was two (2) day perishable and seven (7) day non-perishable amount of food available. LPA observed resident medications were centrally stored and being dispensed daily to residents. No immediate health, safety, or personal rights violations were observed.

No deficiencies cited during today's visit.

Exit interview conducted and copy of the report was left at the facility.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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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