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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003642
Report Date: 02/22/2023
Date Signed: 02/22/2023 11:09:57 AM


Document Has Been Signed on 02/22/2023 11:09 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:CITRUS GARDEN CARE HOMEFACILITY NUMBER:
347003642
ADMINISTRATOR:DRON, LARISAFACILITY TYPE:
740
ADDRESS:5648 TIMMERMAN WAYTELEPHONE:
(916) 965-4055
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:6CENSUS: 4DATE:
02/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Larisa Dron- Administrator TIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced on 02/22/2023 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Administrator , Larisa Dron, and explained the purpose of the visit. LPAs wore the following Personal Protective Equipment (PPE) during today's visit: surgical mask. LPA were screened by facility staff before entry to facility.

LPA and Administrator toured facility together to ensure the health and safety of residents in care. Areas toured include but are not limited to: kitchen, common areas, four (4) bedrooms, two (2) bathrooms, medication closet, garage, laundry room, and backyard. LPA observed two (2) residents in the living room and two (2) residents in their bedrooms. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Administrator completed the infection control domain together and facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of today's inspection.

Exit interview conducted and copy of report left at the facility.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2023
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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