<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004430
Report Date: 03/12/2024
Date Signed: 03/12/2024 01:16:29 PM


Document Has Been Signed on 03/12/2024 01:16 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:POPO'S PLACEFACILITY NUMBER:
347004430
ADMINISTRATOR:RACHEL MILESFACILITY TYPE:
740
ADDRESS:7672 EASTGATE AVENUETELEPHONE:
(916) 961-6248
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 4DATE:
03/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Retha, TIME COMPLETED:
01:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met with caregiver staff, Retha Micheli, and explained purpose of inspection. Manager, Kim Rosa, arrived shortly. LPA observed (3) residents in the common area and (1) resident in her room. The facility is licensed for (6) non-ambulatory residents. Currently, there are no residents on hospice.

LPA and manager toured the interior and exterior of the facility including the common areas, (4) private resident bedrooms (1) shared resident bedroom, (2) resident bathrooms, (1) staff room, kitchen and laundry area, and garage 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. There is sufficient 2+day perishable and 7+day non-perishable supply of food, and sharps, medications and toxins are locked in the kitchen. There are additional locked toxins in the laundry area. The inside temperature measured 72*F and the hot water measured 112*F in the kitchen. The smoke/monoxide alarms are working and the fire extinguisher was last serviced 2/1/24. There are sufficient linens/towels/blankets and paper supplies, including PPE. There are (2) unlocked exits in the backyard. There are no pools with water.

LPA reviewed (2) of (4) resident files and found them to be organized and contain current physician's reports and appraisals. Administrator to provide an updated copy of LIC613C(Personal Rights) to residents/families and also post a copy in the common area. Medications were reviewed for (2) residents- orders on file matched medications administered and medication documentation is current. LPA reviewed (4) staff files and found them to be complete and contain current training documentation, including for First Aid/CPR. Staff completes annual training through an approved on-line vendor. RCFE Administrator renewals are pending. All staff is cleared and associated. LPA requested an updated copy of the LIC308, LIC500 and current liability insurance be provided by 3/19. There are no citations issued but a technical advisory note is being issued today. Exit interview. Copy of report provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1