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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004151
Report Date: 01/21/2025
Date Signed: 01/21/2025 02:17:35 PM

Document Has Been Signed on 01/21/2025 02:17 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:SEGOVIA'S CARE HOME #3FACILITY NUMBER:
347004151
ADMINISTRATOR/
DIRECTOR:		SEGOVIA, NIMFA C.FACILITY TYPE:
735
ADDRESS:6412 SYLVAN ROADTELEPHONE:
(916) 223-5315
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 4DATE:
01/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:05 PM
MET WITH:Nimfa Segovia, Administrator TIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Wilma Tiangco, DSP, and stated the reason for today's inspection. Administrator, Nimfa Segovia, arrived shortly to the facility. The facility is an Adult Residential Facility - level 5 (prior level 4F) that is vendorized through Alta California Regional Center and is licensed for (6) clients. There are currently (4) clients who reside at the care home. LPA observed (0) clients present at the start of the inspection and (1) client return from day program during the inspection.

LPA and care staff 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. There are Covid posters in the common area and other required postings, including House Rules and personal rights (#18). Sharps are locked in the kitchen, medications are secured nearby and toxins are locked in the laundry area. LPA observed sufficient 2+day perishable, including fresh produce, and 7+day non-perishable food. Hot water measured 117*F in the kitchen and inside temperature measured 68*F. First aid kit is complete. Fire extinguisher last serviced 1/6/25 and smoke/monoxide alarms are in working order. The fire door is kept open with an approved device that is activated upon the smoke/monoxide alarms. There is monthly documentation of fire drills. The facility has a large back yard area with seating and various gardens. There are no pools/ponds. The only non-ambulatory resident resides in room #1, per fire clearance. All clients but one chose to have their own room key and staff have an extra set. Administrator certificates are current- ARF- 7035218735- exp 1/13/26. There is sufficient PPE/linens/towels and blankets. Updated email and land line obtained.

(2) client files and (4) staff files were reviewed. All files are organized and contain current documentation, including all required/initial training. P&I and medications were reviewed for (2) clients- no errors were found and documentation is current. There were no deficiencies observed.
Exit interview. Copy of report provided to the Administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/21/2025
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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