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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004151
Report Date: 12/09/2022
Date Signed: 12/09/2022 05:10:20 PM

Document Has Been Signed on 12/09/2022 05:10 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:SEGOVIA'S CARE HOME #3FACILITY NUMBER:
347004151
ADMINISTRATOR:SEGOVIA, NIMFA C.FACILITY TYPE:
735
ADDRESS:6412 SYLVAN ROADTELEPHONE:
(916) 223-5315
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 5DATE:
12/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Chanel Segovia, DSPTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Chanel Segovia, DSP, who contacted Nimfa Segovia, Administrator, who arrived at approximately 1:30 pm from taking a client to a medical appointment. LPA explained purpose of inspection. Prior to initiating today's inspection, LPA completed required department COVID-19 protocols and confirmed the facility was just made aware of (1) new staff who tested positive Covid-19. LPA was The facility recently finished (2) rounds of negative response testing but must begin the process again due to the new positive case. LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and wore an N95 mask The facility is an Adult Residential Facility (level 4F) that is vendorized through Alta California Regional Center. There are (5) clients who reside at the home. LPA observed (5) clients in the facility.

LPA and Administrator toured the interior and exterior of the facility including the common areas, (4) client bedrooms, (2) bathrooms, kitchen, laundry area and backyard.. LPA observed the home to be clean, safe and in good repair. LPA observed various Covid posters throughout as well as other required postings, including House Rules and personal rights. Administrator certificate #6012199735- exp 1/13/2024. Clients have their own tablet and can play games, watch movies and do activities from the day program. Inside temperature was observed to be 68* F. Fire extinguisher last serviced 6/30/2022. Facility conducts monthly fire drills. The facility has a large back yard area with different gardens the residents help to cultivate. There are no pools/ponds. LPA observed locked sharps and medications in the kitchen and locked toxins in the laundry area. LPA observed sufficient 2+day perishable/7+day non-perishable food and sufficient PPE. LPA observed paper towels, soap, sanitizer, trash cans with lids and hand-washing posters in the bathroom. Discussed resident and staff vaccination status and eligibility for booster shot. LPA provided booster flyer. Discussed visitation protocols. LPA obtained an updated copy of the LIC308 during today's inspection.

There were no deficiencies observed. Exit interview. Copy of report requested to be emailed.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2022
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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