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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002924
Report Date: 02/03/2023
Date Signed: 02/03/2023 05:16:40 PM


Document Has Been Signed on 02/03/2023 05:16 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: 2DATE:
02/03/2023
TYPE OF VISIT:Post LicensingANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Janelyn Kelly, Administrator and Jhamil Espino,LicenseeTIME COMPLETED:
05:10 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a post-licensing inspection. LPA met with Janelyn Kelly, Administrator, and explained purpose of inspection. Also present were staff, Jacob Espino and Manjit Kaur. Jhamil Espino, Licensee arrived during the inspection. Prior to initiating today's inspection, LPA completed required COVID-19 department protocols and was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and wore a:surgical mask. There are (2) clients currently and (0) clients receiving hospice services. LPA observed (1) client to be in the common area and (1) client to be in her room.

LPA and Administrator toured the interior and exterior of the facility including the common areas, (6) private resident bedrooms, (2) resident full bathrooms, (2) resident half bathrooms, kitchen, laundry/storage area, activity room, staff room. LPA observed the home to be clean, safe, in good repair and to not pose a health and safety risk or personal rights violation. All vacant resident rooms had required furniture in them. LPA observed sharps and medications to be locked in the kitchen and locked toxins in the laundry area. LPA observed sufficient 2+day perishable/7+day non-perishable supply of food and sufficient paper products and PPE on hand. LPA observed paper towels, soap, sanitizer, trash cans with lids and 20-second hand-washing poster in each bathroom. Discussed resident and staff vaccination status. Inside temperature was observed to be 71* F. Fire extinguisher last serviced 3/7/22. The facility has a back yard area with covered seating and there is (1) unlocked exit gate. LPA observed various Covid posters and PIN 22-28.1 regarding visitation protocols to be posted outside front entrance. LPA observed other Covid posters and required postings throughout. All staff are cleared and associated. LPA observed current Administrator certificate # 6062074720- exp 1/19/24. LPA reviewed the facility Infection Control Plan, obtained through an outside approved vendor, and found it to be comprehensive. LPA reviewed (1) resident file and found it to be complete and contain current documentation. LPA obtained a current copy of liability insurance. Also discussed was how to obtain fire approval to convert (2) ambulatory rooms to (2) non-ambulatory rooms.

There were no deficiencies observed. Exit interview. Copy of report left at facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2023
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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