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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000701
Report Date: 09/27/2023
Date Signed: 09/27/2023 03:49:17 PM

Document Has Been Signed on 09/27/2023 03:49 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: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: 3DATE:
09/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Heta Finau, Administrator TIME COMPLETED:
03:50 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
Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Heta Finau, Administrator, and explained purpose of inspection. LPA then met with Sione Finau, staff, who arrived at approximately 2:45 pm. LPA observed (3) clients return from day program during today's inspection. The facility is a level- 2 home, vendorized by Alta Cailfornia Regional Center.

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. Inside temperature was observed to be 77*. Facility conducts monthly fire drills. The smoke/monoxide alarms work. Hot water temperature measured 108*F in the kitchen. LPA observed sufficient 2+ day perishable and 7+day non-perishable supply of food in the kitchen. LPA observed locked sharps, toxins and medications in the kitchen. First Aid kit complete with required supplies.

LPA reviewed (1) of (3) staff files and (2) of (3) client files. Files were organized and contained current documentation of training and care plans (Regional Center) done annually for a Level 2 home. (2) staff to complete required (12) hours of annual training by 12/15/23. Administrator submitted renewal paperwork and fees for Administrator Certificate on/around June 2023. LPA reviewed P&I funds for (2) clients and funds on hand match records. Medications were reviewed for (1) client - no discrepancies were found.

LPA printed out LIC610E(9 pages) for facility to complete/update. LPA reviewed the Infection Control Plan (LIC9282) completed and approved it.

Administrator to provide updated copy of LIC308, LIC500, LIC610E to LPA by 10/4/23
.
A technical advisory note was issued regarding Pub 475 not posted.
Exit interview. Copy of report provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2023
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