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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003642
Report Date: 02/14/2024
Date Signed: 02/14/2024 02:53:40 PM


Document Has Been Signed on 02/14/2024 02:53 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: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: 3DATE:
02/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Administrator- Larisa DronTIME COMPLETED:
03:00 PM
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On 02/14/24 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a required- 1 year annual inspection utilizing the care tool. LPA met with Administrator, Larisa Dron and explained the purpose of visit.

LPA and Administrator conducted a tour of the facility. Areas toured included but not limited to the kitchen, dining room, four (4) residents bedrooms, staff room, two (2) bathrooms, garage, common areas and backyard. LPA observed sufficient furniture and lighting throughout the facility. During the tour LPA observed two (2) residents in their bedrooms and one (1) resident in the living room watching television.

LPA observed the facility to have sufficient food supplies for seven (7) day non-perishable and two (2) day perishable. LPA observed toxins, knives and centrally stored medications to be locked and inaccessible to residents in care. All required Licensing posters are present in the facility. Hot water temperature was measured at 112.8 degrees Fahrenheit at the kitchen sink, which is within the required range of 105 to 120 degrees. The temperature in the facility was 73 degrees. Fire extinguishers was last inspected on 01/23/24. Smoke detectors are working and present throughout the facility. LPA observed carbon monoxide detectors throughout the facility. First Aid kit is maintained and ready for emergency use.

LPA conducted a file review of three (3) resident files and two (2) staff files. LPA observed all resident files and staff files to be in compliance.

LPA requested a copy of the current liability insurance to be sent to LPA Ratajczak by 02/28/24.

LPA completed the full care tool and no deficiencies was observed.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Cheyenne RatajczakTELEPHONE: (916) 969-7879
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2024
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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