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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000878
Report Date: 07/12/2024
Date Signed: 07/12/2024 02:25:26 PM


Document Has Been Signed on 07/12/2024 02:25 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:PHYLLIS' CARE HOMEFACILITY NUMBER:
347000878
ADMINISTRATOR:JAR, ALINAFACILITY TYPE:
740
ADDRESS:6924 LE HAVRE WAYTELEPHONE:
(916) 722-0824
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:6CENSUS: 3DATE:
07/12/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Alina Jar, Administrator and Dan Jar, caregiver TIME COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection following receipt of a report that the air conditioning (A/C) unit was not functioning properly. LPA met with Alina Jar, Administrator and Dan Jar, caregiver, and stated the reason for today's inspection. LPA was informed that the Ombudsman had just conducted an inspection also.

LPA observed (2) residents resting in the common area and (1) resident resting in her room. LPA observed the A/C unit to be operating from the garage window outside, near the front entrance. LPA observed the inside temperature to feel comfortable and the thermostat showed 75*F.

LPA was informed that 9-10 days ago, the A/C unit was not functioning optimally, and so the Administrator reached out to the company that handles the maintenance on the warranty, but an appointment was not able to be scheduled until 7/18/24. The Administrator contacted a friend who inspected the A/C unit on 7/10/24 and serviced the unit, which included cleaning a coil and repairing a leak. During the week the unit was not working optimally, multiple fans were used throughout the care home, and continue to be used, to ensure the inside temperatures remained in compliance (68*-85*F) and no more than 30*F from the outside temperature. Regulation 87303 Maintenance and Operation was discussed to ensure its understanding.

LPA toured the facility and observed all rooms to be cool and comfortable, with the common areas the coolest. One resident, who was awake, stated to LPA she has been comfortable with the inside temperatures these past 10 days, and was observed to be using a blanket in her recliner chair. LPA contacted Licensing Program Manager to let her know there do not appear to any concerns at this time, which is in agreement with the Ombudsman's inspection from today. The Administrator agreed to follow up with her assigned LPA next week on 7/18/24.

There are no deficiencies cited in this report. Exit interview. Copy of report provided to the Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2024
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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