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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001498
Report Date: 02/23/2023
Date Signed: 02/23/2023 02:52:27 PM


Document Has Been Signed on 02/23/2023 02:52 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:CITRUS HEIGHTS TERRACEFACILITY NUMBER:
347001498
ADMINISTRATOR:TINA PREWITTFACILITY TYPE:
740
ADDRESS:7952 OLD AUBURN ROADTELEPHONE:
(916) 727-4400
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:45CENSUS: 45DATE:
02/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Tina Prewitt, Administrator TIME COMPLETED:
02:55 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection. LPA met with Tina Prewitt, Administrator, and explained purpose of inspection. Prior to initiating today's inspection, LPA completed required COVID-19 Department protocols and was screened per Covid-19 precautionary measures upon entering the facility and was wearing a surgical mask. The facility is licensed for 48 non-ambulatory residents who have a diagnosis of Dementia, 8 of whom may be bedridden, and has a hospice waiver for 17 residents. There are currently 7 residents on hospice. LPA to provide an updated copy of the facility license to reflect the approved hospice waiver.

LPA, Administrator and Maintenance Lead, toured the interior and exterior of the facility including the common areas, (2) resident rooms, medication room, dining rooms, activity room, salon, kitchen and staff lounge. LPA observed the facility to be clean, in good repair, odor free and the bathrooms to have paper towels, soap, trash cans with lids. LPA observed a 20-second hand-washing poster above each bathroom and kitchen sink. Fire extinguishers observed throughout and to have last been serviced on 6/1/2022. All exit doors and front entrance door are equipped with an egress door alarm. LPA observed hand sanitizers in the common area. There is an enclosed courtyard with seating for residents. LPA observed the inside temperature to be 72-74*F. LPA observed 2+day perishable and 7+day non-perishable supply of food in the kitchen and the refrigerator/freezer temperatures to be recorded daily. Fire Dept conducted an annual exam on/around November 2022 and everything was found to be in compliance. LPA observed an abundant supply of all types of PPE and incontinent products on site. LPA observed required postings and Covid posters as well and was advised the RCFE Administrator certificate has been renewed. All staff is cleared and associated. Administrator to review and updated roster as needed. Discussed current vaccination status of residents and staff and eligibility for newest Booster. Booster flyers provided. Discussed recent PIN 23-02 issued 2-9-23 providing an update on testing, isolation, quarantining and masking. LPA obtained a copy of LIC308 and current liability insurance during today's inspection. LIC500 to be provided by 3/2/23. There were no deficiencies observed during today's inspection. Exit interview. Copy of report left.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2023
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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