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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001766
Report Date: 10/12/2023
Date Signed: 10/12/2023 04:25:39 PM

Document Has Been Signed on 10/12/2023 04:25 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:JOWELLA CHICO'S CARE HOMEFACILITY NUMBER:
347001766
ADMINISTRATOR:CRISTINA CHICOFACILITY TYPE:
735
ADDRESS:8442 SUNRISE BOULEVARDTELEPHONE:
(916) 726-7283
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 5DATE:
10/12/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Jowella Chico, Administrator TIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection to follow up on an incident report (SIR) in September 2023, and a required annual (separate report). LPA met with Ana Lou Zabala, Maria Lina and Maria Rope Chico, DSP's, and explained purpose of inspection. Also present was Angelo Chico, DSP. LPA spoke with Jowell Chico, Licensee, by phone, who arrived shortly to the facility. LPA observed (5) of (5) clients in the common area. The property is enclosed by a vehicle gate that operates manually. The gate is not locked.

The Department received an SIR by email on 9/20/23 for an incident occurring on 9/13/23 with client (C1). LPA discussed the incident with the Licensee who confirmed that on 9/13/23 at approximately 1:00 pm, shortly after another client was being returned to the facility from the day program, (C1) was able to exit from the open front vehicle gate. The gate remained opened while the driver of the day program was completing some paperwork in the vehicle at least (20-30) minutes, which is not standard protocol. Staff were inside the care home providing lunch and administering medications to the other residents. (C1) had stated she was going to take a nap just prior to exiting. Licensee stated that all staff present looked for (C1) in the facility and outside on the patio and when they couldn't locate (C1), they called 9-1-1. (C1) was brought back to the facility at 1:35 pm, by the police, who were able to locate her due to wearing a monitoring device for elopement tendencies. On 9/20/23, a meeting was held to discuss possible medication changes, but it is still being discussed.

LPA and Licensee discussed how there should be continuous staff supervision outside from when the gate is manually opened until it is manually closed, which would have prevented (C1) from leaving unassisted.

Per California Code of Regulation, Title 22, Division 6, Chapter 8, the following (1) citation is issued on the 809-D page.

Exit interview. Copy of report and appeal rights provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023
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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Document Has Been Signed on 10/12/2023 04:25 PM - It Cannot Be Edited


Created By: Sabrina Calzada On 10/12/2023 at 03:50 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: JOWELLA CHICO'S CARE HOME
FACILITY NUMBER: 347001766

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/13/2023
Section Cited
CCR
85065(b)

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85065 Personnel Requirements
(b) The licensee shall employ staff as necessary to ensure provision of care and supervision to meet client needs.
This requirement is not met as evidenced by:
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Licensee/Administrator agree to conduct staff training on following consistent protocols with staff being present when the gate is opened and until it closed.
Licensee will send completed training by Monday, 10/16/23 and will submit agenda by tomorrow, 10/13/23.
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Based on documentation reviewed and interview conducted, the Licensee did not ensure that (C1) was provided with sufficient supervision, while the vehicle gate was open, to prevent her from exiting the facility, which posed an immediate health and safety risk to clients in care.
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Licensee agrees to also contact local fire department for possible approval of a locked front gate due to having a safe dispersal area in the back.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maribeth Senty
LICENSING EVALUATOR NAME:Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023


LIC809 (FAS) - (06/04)
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