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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000701
Report Date: 10/06/2022
Date Signed: 10/06/2022 04:52:29 PM

Document Has Been Signed on 10/06/2022 04:52 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:HETA FINAUFACILITY NUMBER:
347000701
ADMINISTRATOR:FINAU, HETAFACILITY TYPE:
735
ADDRESS:7804 JANA MARIE COURTTELEPHONE:
(916) 410-1756
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 4CENSUS: 4DATE:
10/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:35 PM
MET WITH:Sione Finau, Co-Administrator TIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Sione Finau, Co-Administrator, and explained purpose of inspection. LPA then met with Heta Finau, Administrator, who returned to the facility at 4:00 pm from a medical appointment with a client. Prior to initiating today's inspection, LPA completed required COVID-19 protocols. LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask.The facility is a licensed 2 home, vendorized by Alta Cailfornia Regional Center.LPA observed (3) clients to be home during the inspection and (1) client to return from a medical appointment with his responsible person.

LPA and Administrator toured the interior and exterior of the facility including the common areas, (2) client bedrooms, (2) client bathrooms, kitchen, Administrators' room and bathroom, and laundry area. LPA observed the home to be clean, safe and in good repair and to not pose a health and safety risk or personal rights violation. LPA observed various Covid posters and other required postings to be posted. Administrator to post CCLD See Something Say Something poster in a conspicuous area. Inside temperature was observed to be 83*. Facility conducts monthly fire drills, and the fire extinguisher was last serviced on 8/22/2022. The facility has a large back yard area with seating. LPA observed locked toxins, medications and sharps and sufficient 2+day perishable/7+day non-perishable food. LPA observed paper towels, soap, trash can with lid and 20-second hand-washing posters in the bathrooms. PPE supply on hand is sufficient. LPA provided (4) individual sanitizers from Department. Discussed resident and staff vaccination status and eligibility for booster shot and provided booster flyer. Discussed current visitation protocols. LPA observed Administrator certificate #6004413735 exp 7/23/2023 to be current. LPA observed (1) unlocked exit gate from the inside. Facility carpets to be cleaned tomorrow. LPA obtained updated contact information for facility.

There were no deficiencies observed. Exit interview. Copy of report left at facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2022
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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