<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003628
Report Date: 09/27/2022
Date Signed: 09/27/2022 03:26:48 PM


Document Has Been Signed on 09/27/2022 03:26 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:SUGAR MAPLE CARE HOMEFACILITY NUMBER:
347003628
ADMINISTRATOR:SOTEA, FLORICAFACILITY TYPE:
740
ADDRESS:6737 SUGAR MAPLE WAYTELEPHONE:
(916) 222-2022
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 6DATE:
09/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Florica Sotea, Administrator TIME COMPLETED:
03:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Jennifer Blake, caregiver, who contacted Florica Sotea, Administrator,by phone. Administrator arrived at approximately 1:45 and Eugene Georgescu, back-up Administrator staff, arrived at approximately 2:00 pm. LPA explained purpose of inspection. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and confirmed the facility does not currently have any positive Covid-19 diagnoses. LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. There are (6) clients who reside at the home. LPA observed (6) clients in the facility and was advised (0) clients are on hospice.

LPA and DSP toured the interior and exterior of the facility including the common areas, (4) client bedrooms, (2) bathrooms, kitchen, laundry area, garage/storage area. LPA observed the home to be clean, safe and in good repair and to not pose a health and safety risk or personal rights violation. Inside temperature was observed to be 77* F. Fire extinguisher last serviced 3/18/2022. Facility conducts quarterly fire drills and the smoke/monoxide alarms are in working order. The facility has a back yard area with covered seating and there is (1) unlocked exit gate. There are no pools/ponds. LPA observed toxins, sharps and medications to be locked in a separate areas. LPA observed sufficient 2+day perishable/7+day non-perishable food and sufficient PPE on hand. LPA observed paper towels, soap, sanitizer, trash cans. Administrator to post 20-second hand-washing posters by each sink. Discussed resident and staff vaccination status and eligibility for booster shot. LPA provided booster flyer. Discussed visitation protocols. LPA observed organized binders with staff training documentation as well as binders containing the Covid-19 Mitigation Plan, Monkey Pox and Infection Control plans. LPA requested updated copy of LIC610E, LIC308 and current copy of liability insurance be faxed by 10/3/22.
There were no deficiencies observed. Exit interview. Copy of report left at facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1