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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001766
Report Date: 10/17/2024
Date Signed: 10/17/2024 02:12:13 PM

Document Has Been Signed on 10/17/2024 02:12 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:JOWELLA CHICO'S CARE HOMEFACILITY NUMBER:
347001766
ADMINISTRATOR/
DIRECTOR:		CRISTINA CHICOFACILITY TYPE:
735
ADDRESS:8442 SUNRISE BOULEVARDTELEPHONE:
(916) 726-7283
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 4DATE:
10/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Jowella Chico, Administrator TIME VISIT/
INSPECTION COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Ana Lou Zabala and Angelo Chico, DSP's. Administrator, Cristina Chico, arrived around 11:30 am. Licensee, Jowella Chico, arrived around 11:45 am, after returning from an appointment with a client.
The facility is a licensed 4I - Prader Willi home that is vendorized through Alta California Regional Center for (6) ambulatory clients only. LPA observed (1) client present initially. (3) clients returned during the inspection. There is a vehicle gate and pedestrian gate at the front of the property. A staff member was outside when LPA arrived and opened the unlocked sliding vehicle gate so LPA could park on site.

LPA and the Administrator toured the interior and exterior of the facility and observed it to be clean, in good repair and odor free. LPA observed locked toxins, medications and sharps and sufficient 2+day perishable/7+day non-perishable food. The pantry is organized with each shelf labeled. The food and refrigerator are locked due to clients having Prader-Willi Syndrome. Hot water temperature measured 111*F in a client bathroom. LPA observed paper towels, soap, and trash can in the bathroom. Fire extinguisher was last serviced 10/14/24 and the smoke/monoxide alarms are working. Each client room has a locking mechanism, per Title 17. Each client has been issued a key that wants a key. The facility keeps a copy for emergencies. There are sufficient linens/towels/paper products, and a complete First Aid kit. There are games/activities on site, and sufficient outdoor space for activities.

LPA reviewed )2 client files and found them to be organized, complete and contain current documentation. Medications were reviewed for (2) clients- no discrepancies were noted and the facility is correctly documenting on the Medication Administration Record, LIC622 and for PRN meds. P&I funds were reviewed for (2) clients and there were no errors noted. LPA reviewed (4) staffing files and found them to be organized and contain current training documentation, including First Aid/CPR. Administrator Certificate current- # 6036853735- exp 1/17/25. Administrator Certificate current- # 6036853735- exp 1/17/25. Updated email and cell phone obtained. There cited during today's inspection. Exit interview. Copy of report given to Licensee.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2024
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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