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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001947
Report Date: 11/16/2022
Date Signed: 11/16/2022 04:55:32 PM


Document Has Been Signed on 11/16/2022 04:55 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:EVA'S CARE HOMEFACILITY NUMBER:
347001947
ADMINISTRATOR:NEMETHY, EVAFACILITY TYPE:
740
ADDRESS:8220 CATALPA DRIVETELEPHONE:
(916) 727-1904
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 3DATE:
11/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Eva Nemethy, Administrator TIME COMPLETED:
04:55 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met with Robert Kovacs, caregiver, and explained purpose of inspection. LPA met with Eva Nemethy, Administrator, who arrived at 2:45 pm. LPA observed all (3) residents to be in their rooms at the start of the inspection. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (2). Currently, there are (0) residents on hospice. Prior to initiating today's inspection, LPA completed required COVID-19 Department protocols and wore a surgical mask. LPA observed sanitizer and PPE at the front entrance and advised Administrator to resume screening visitors, using a visitor sign-in book and to re-post "mask required" poster.

LPA and the Administrator toured the interior and exterior of the facility including the common areas, resident bedrooms (6), resident bathrooms (3), kitchen, staff room and laundry area. LPA observed the facility to be clean, in good repair and odor-free. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels. Administrator agreed to post a 20-second hand-washing poster at each kitchen and bathroom sink. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps and toxins in the kitchen. LPA observed the inside temperature to be 71*F. Fire extinguisher was last serviced 2/16/2022.

LPA observed multiple Covid posters throughout as well as other required postings. LPA observed (1) unlocked gate from the inside back patio. There are no bodies of water or a pool. LPA observed the materials outside on the lawn to assemble a second shed in the backyard and some bags of recyclables and other items to be stored in the shed. LPA observed sufficient incontinent products and PPE on hand. LPA and Administrator completed the Infection Control Domain questions. LPA discussed resident/staff vaccination status, provided Booster flyer and booster exemption form, if applicable.

LPA requested a copy of the current liability insurance, LIC500, and LIC308 be provided to the Department by 11/23/22. Exit interview. Copy of report left with Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2022
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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