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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003229
Report Date: 03/06/2025
Date Signed: 03/06/2025 05:32:51 PM

Document Has Been Signed on 03/06/2025 05:32 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:SHADY OAKS CARE HOMEFACILITY NUMBER:
347003229
ADMINISTRATOR/
DIRECTOR:
MARJORIE REBOJAFACILITY TYPE:
740
ADDRESS:7209 CROSS DRIVETELEPHONE:
(916) 723-4911
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 5TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
03/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:35 PM
MET WITH:Marjorie Reboja, Administrator TIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met with Marjorie Reboja, Administrator, and explained purpose of inspection. LPA observed (2) residents present in the common area and (2) residents resting in their rooms. The facility is licensed for (5) non-ambulatory residents and has a hospice waiver for (2). Currently, there are no residents on hospice. Licensee, Fortunata Reboja, was outside sweeping on the patio and staff, Peter Reboja, was present also.

LPA and Administrator toured the interior/exterior of the facility including the common areas, (3) resident bedrooms, (2) full bathrooms, kitchen, and locked laundry area on the first floor. The second floor of the facility is used by the Administrator. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels, soap and trash can. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps and medications in the kitchen, and locked toxins in the laundry area. Fire extinguisher was last serviced 10/1/24 and the smoke monoxide alarms are working. There are required postings in the common area, including Resident Rights. The facility will complete a quarterly an emergency drill by 3/13/25. There are sufficient linens/towels/paper products/PPE. Inside temp measured 71*F . Hot water measured 110*F in the kitchen. Administrator to advise of any staffing changes.

LPA reviewed (2) resident files which were to be organized. Both care plans to be current but will need updating by 3/19/25. (1) physician's report was current and Admin to request the second resident schedule a physical. (2) residents have doctors who visit in person. Medications were reviewed for (1) residents. Medications matched orders and Administrator will obtain a PRN order for an allergy medication for (R1) and will submit a copy of the prescription to Department. LPA reviewed (3) staff binders. All staff have current certification in First Aid/CPR- expires March 2026 . Administrator certificate #7003027740- exp 2/10/26; Administrator Designee/staff, has RCFE# 7010345740- exp 5/21/25. All staff is cleared and associated. There is (1) unlocked gate from the inside back patio. (2) light bulbs were replaced in a bathroom today.

There are no deficiencies issued in this report.
Exit interview. Copy of report provided to the Administrator.
Maribeth SentyTELEPHONE: (916) 263-4813
Sabrina CalzadaTELEPHONE: (510) 829-2133
DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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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