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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002953
Report Date: 12/19/2023
Date Signed: 12/19/2023 04:48:14 PM


Document Has Been Signed on 12/19/2023 04:48 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:TUSCAN PALMS HOME CARE LLCFACILITY NUMBER:
345002953
ADMINISTRATOR:TIMIS, ALEXANDRU VICTORFACILITY TYPE:
740
ADDRESS:7921 ALMA MESA WAYTELEPHONE:
(279) 529-2363
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 5DATE:
12/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Alex Timis, Administrator TIME COMPLETED:
04:35 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Alex Timis, Administrator, and explained purpose of the inspection. Also present was Angela Reckford-Campbell. LPA observed (1) resident watching television in the common area and (4) residents in their rooms. The facility is licensed for (6) residents - (5) can be bedridden and (1) must be ambulatory. Resident in room #1 is ambulatory per physician's report. There is a hospice waiver approved for (2) residents. Currently there is (1) resident on hospice.

LPA and Administrators toured the interior/exterior of the facility including the common areas, resident bedrooms (6), resident bathrooms (3.5), kitchen, staff rooms, laundry and medication/office area. All resident rooms are private and (5) have a sliding exit glass door. LPA observed the facility to be clean, in good repair and to have sufficient furniture/lighting. Resident bathrooms (3) have a walk-in shower with grab bars, non-skid flooring, paper towels, trash cans with a lid and hand-washing posters (40-60 seconds). There is sufficient 2+day perishable food, including fresh produce, and 7+day non-perishable supply of food. Sharps and medications are locked in/near the kitchen and toxins are locked in the laundry area. The inside temperature was 73*F and hot water measured 110*F in the kitchen. Fire extinguisher last serviced 2/7/23. Smoke/monoxide alarms are working, and the last quarterly fire drill was conducted on 10/24/23. There are sufficient PPE supplies, linens, blankets, and towels. There are activities on hand, sufficient indoor/outdoor space and take seasonal outings. RCFE Administrator certificate # 6004832740 is pending renewal. LPA reviewed (3) resident files which were found to be organized and contain current/required documentation. Medications were reviewed for (2) residents- orders match medications on hand and documentation is current. (3) staff files were reviewed and found to be organized and contain current training documentation, completed through an approved department vendor. The Infection Control Plan was reviewed and found to be comprehensive. All required postings were observed. A copy of current liability insurance, LIC308 and LIC500 were obtained during today's inspection.
There were no deficiencies observed. Exit interview. Copy of report provided to Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2023
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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