<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002946
Report Date: 10/12/2022
Date Signed: 10/12/2022 03:19:52 PM


Document Has Been Signed on 10/12/2022 03:19 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 CREST CARE HOME 2FACILITY NUMBER:
345002946
ADMINISTRATOR:SOUMAHORO, MUAMOUDOUFACILITY TYPE:
740
ADDRESS:6813 MARINVALE DRTELEPHONE:
(916) 904-0027
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:6CENSUS: 4DATE:
10/12/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Admininstrator- Muamoudou Bob Soumahoro TIME COMPLETED:
04:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On October 12, 2022 at 2:20pm, Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility to conduct a Pre-Licensing inspection and met with Administrator, Muamoudou Bob Soumahoro.

LPA toured and inspected the indoor and outdoor premises of the facility with administrator to ensure there are no health and safety concerns. Indoor and outdoor passageways were free of obstruction.

The facility has (5) five bedrooms and (4) bathrooms. LPA observed the kitchen area, living room, bedrooms, bathrooms, storage area, garage, and dining room. LPA observed knives/ sharps were locked in the kitchen cabinet. LPA observed toxic and cleaning supplies locked underneath the kitchen sink. LPA observed food supplies of non-perishables for a minimum of one week and perishable foods for a minimum of two days. LPA observed required furniture, and lighting throughout the facility. Bathrooms are clean, sanitary, and in good repair. The hot water temperature was measured in the kitchen at 110 degrees Fahrenheit. First aid kit was completed with bandages, tweezers, scissors, and thermometer. LPA observed centrally stored medications area were locked and inaccessible to residents in care. Facility has sufficient supplies of PPE, paper, hygiene, and incontinence. There are two ramps located in the backyard. Both are free of obstruction. Residents and staff are able to use ramps to exit from to the front in case of an emergency.

LPA observed one (1) fire extinguisher, smoke and carbon monoxide detectors in the facility. Licensing complaint poster are posted as required.

Component III presentation conducted with administrator.

LPA observed that the facility is ready to be licensed. This report will be submitted to the Central Applications Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required.

An exit interview was conducted with administrator.

SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1