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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002924
Report Date: 08/23/2022
Date Signed: 08/23/2022 01:57:34 PM


Document Has Been Signed on 08/23/2022 01:57 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:CITRUS PINES SENIOR LIVINGFACILITY NUMBER:
345002924
ADMINISTRATOR:KELLY, JANELYNFACILITY TYPE:
740
ADDRESS:8300 PATTON AVETELEPHONE:
(279) 529-2045
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 0DATE:
08/23/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Jhamiel Espino, Licensee & Janelyn Kelly, AdministratorTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Jacob Williams met with facility Licensee Jhamiel Espino to conduct a Pre- Licensing visit. LPA followed current Covid precautions: self screened, hand sanitized and surgical mask was worn. Another staff member, Administrator Janelyn Kelly, was also present during today's visit.

The facility has a fire clearance for 3 ambulatory, 2 non-ambulatory and 1 bedridden resident. Room #1 & #2 are approved for non-ambulatory, room #3 approved for bedridden, rooms #4-6 ambulatory only.



LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are six (6) resident bedrooms, and four (4) resident bathrooms. LPA observed facility to be properly furnished, including appropriate bedding and lighting in the facility. Bathrooms are in sanitary condition and properly maintained. There are two staff bedrooms located on western wing of facility.

LPA checked the kitchen area for the ability to prepare and store food. LPA observed cleaning products and other toxins to be locked away. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detectors at the care home to be operational. Fire extinguisher and first aid kit are maintained and ready for emergency use.

Pre-licensing passed and Component III (RCFE) was completed with Jhamiel and Janelyn. Facility has satisfied all requirements in accordance to Title 22, California Code of Regulations. Application is pending and LPA will forward findings to the Centralized Application Bureau (CAB) for final review and approval. CAB will further contact applicant on final status of application. A copy of this report was provided to the facility. Exit interview conducted and copy of report left at facility.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Jacob WilliamsTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2022
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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