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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002892
Report Date: 02/20/2025
Date Signed: 02/20/2025 02:22:23 PM

Document Has Been Signed on 02/20/2025 02:22 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: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: 4DATE:
02/20/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Staff-Karen MutukuTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 02/20/2025, Licensing Program Analysts (LPAs) Cheyenne Ratajczak and Cassandra Mikkelson arrived at the facility unannounced to conduct a case management visit to follow up on the incident report the department received today 02/20/2025. LPAs met with Staff Karen Mutuku and explained the purpose of the visit. LPA notified 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.

LPAs spoke with staff Karen Mutuku regarding an incident that took place on 02/19/2025. Staff interview indicated that Resident #1 (R1) is currently in the hospital and has no plan to return. LPAs conducted a file review of R1s file and Resident #2 (R2) files. Based on interview with staff, facility followed the proper protocol with reporting the incident to Community Care Licensing (CCLD) within 24 hours.

At this time, 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: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
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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