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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920099
Report Date: 02/02/2024
Date Signed: 02/02/2024 04:14:10 PM


Document Has Been Signed on 02/02/2024 04:14 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:SPRING AZURE SENIOR CAREFACILITY NUMBER:
345920099
ADMINISTRATOR:CHUA-HARRIS, CHRISTIAN DYAFACILITY TYPE:
740
ADDRESS:6924 OAK SPRING WAYTELEPHONE:
(916) 579-9222
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:6CENSUS: 0DATE:
02/02/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Christine Chua- Harris, Administrator and Shane Harris,Co-LicenseseTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived announced to conduct a pre-licensing inspection at 2:15 pm on 2/2/24. LPA met with Christine Chua- Harris, Administrator and Shane Harris, Co-Licensese. There are currenly no residents present as this location has a new license pending.

LPA, Administrator and Licensee toured the interior and exterior of the facility including the common areas, (2) private resident bedrooms (2) shared resident bedrooms, (2) resident bathrooms, kitchen, office area and laundry/garage. LPA observed the facility to be clean, have newly remodeled rooms equipped with furniture and lighting throughout. The bathrooms have the necessary grab bars, and non-skid flooring- to post 20-second hand-washing posters. LPA observed some non-perishable food and dishes, flatware and cooking pans in the kitchen. Sharps and toxins are locked in the kitchen using magnetic locks. Medications will be stored in a locked cabinet in the office area. LPA observed a patio table and chairs and (2) unlocked exit gates in the backyard. All exit doors have alarms. The inside temperature measured 68*F. Fire extinguishers were last serviced on 11/6/23. LPA observed a complete First Aid kit and sufficient PPE and paper supplies. All smoke/monoxide alarms work. Water temperature measured 114*F in the kitchen. Refrigerator/freezer measured 37*F/0*F, within regulation. LPA observed sufficient linens/towels/blankets. LPA observed various required postings posted, including the Emergency Disaster Plan and Theft & Loss Policy. LPA observed some games/activities and an operating land line. LPA reviewed a sample resident file and found it to contain all the required forms. Staff files are digitized. Administrator to repair two small tears in two window screens by tomorrow.

Component III was reviewed during today’s inspection.

Pre-Licensing is complete and this facility has no deficiencies.

Exit interview. Copy of report left at facility. LPA to notify to the Centralized Applications Bureau.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2024
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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