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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003628
Report Date: 10/11/2023
Date Signed: 10/11/2023 02:50:47 PM


Document Has Been Signed on 10/11/2023 02:50 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: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: 5DATE:
10/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Florica Sotea, Administrator TIME COMPLETED:
02:55 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Florica Sotea, Administrator, and Camille Whyte, caregiver, and explained the reason for the inspection. LPA was advised that (1) of (6) residents is currently at a skilled nursing facility. The facility has a hospice waiver for (3). There are no residents on hospice currently.

LPA and Administrator toured the interior and exterior of the facility including the common areas, (2) shared resident rooms, (2) private resident rooms, (2) resident bathrooms, kitchen, staff room and garage/locked 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 and hand-washing posters. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps in the kitchen. Locked medications are kept in a separate cabinet nearby and locked toxins are kept in the garage. LPA observed the inside temperature to be 73*F. Fire extinguisher was last serviced 4/10/23. Hot water temperature measured 110*F in a resident bathroom. There is a complete First Aid kit on site and sufficient paper products and PPE. All required postings are posted.

LPA reviewed/approved the Infection Control Plan (LIC9282) that was last updated in August 2023. LPA observed (1) unlocked gate outside and covered patio seating. There are no pools or bodies of water. LPA observed copy of RCFE Administrator certificate # 6025371740- exp 5/15/23- renewal pending. LPA reviewed (3) resident files and found them to be organized, current and complete. Meds were reviewed for (2) residenst -orders matched meds being administered. LPA reviewed all staff files - all staff have current First Aid/CPR certification and have completed required training through an approved on-line vendor. LPA requested an updated copy of LIC500, LIC308 and obtained a copy of the current liability insurance. There are no deficiencies issued during today's inspection.

Exit interview with Administrator. Copy of report provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2023
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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