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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005202
Report Date: 02/21/2025
Date Signed: 02/21/2025 04:46:58 PM

Document Has Been Signed on 02/21/2025 04:46 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ST. CHRISTOPHER MANORFACILITY NUMBER:
347005202
ADMINISTRATOR/
DIRECTOR:		BENITEZ, NORMAFACILITY TYPE:
740
ADDRESS:8564 BRENTWICK WAYTELEPHONE:
(916) 509-9819
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY: 4TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
02/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Norma BenitezTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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On 2/21/2025 at 1:20 P.M. Licensing Program Analysts (LPAs) Cynthia Tamayo and Kevin Gould arrived at St. Christopher Manor RCFE for the purpose of conducting a required 1 year annual inspection. LPAs met with Administrator, Norma Benitez and together conducted a tour of the home.

LPAs and Administrator evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPAs observed the facility to be free of odor and clean. LPAs observed there was a screen door that is listed as an emergency exit is not working properly and cannot be opened. LPAs observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility.

LPAs measured the water temperature, temperature measured at 124 degrees F which does not meet the 105-120 degree Fahrenheit regulation and the administrator was able to lower the hot water temperature so it meets the 105-120 degree. LPAs observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPAs notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPAs observed centrally stored medications secure from residents.

LPA Requested the following documents for facility file: LIC 308 Designation of Facility Responsibility, LIC 500 personnel report, LIC 309 Administrative Organization ,LIC 999 Facility Sketch, and LIC 9020 client roster and current administrator certificate. The Dementia training requirement was not met for one staff member.

Per California Code of Regulations, Title 22 the following deficiencies are cited during today's inspection. An exit interview was conducted, and a copy of this report and appeal rights were left at the facility.
Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
Cynthia TamayoTELEPHONE: (916) 225-3582
DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
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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Document Has Been Signed on 02/21/2025 04:46 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: ST. CHRISTOPHER MANOR
FACILITY NUMBER: 347005202

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
CCR
87303(a)
Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above as LPA observed the sliding screen door from one of the designated emergency exits does not open and is in need of repair which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/03/2025
Plan of Correction
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Licensee has agreed to ensure the sliding screen door will be repaired by the POC due date, 03/03/2025
Type B
Section Cited
HSC
1569.625(b)(2)
Other Provisions
(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA record review, the licensee did not comply with the section cited above in 1 out of 1 staff members does not have the eight hour dementia training which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/21/2025
Plan of Correction
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Licensee has agreed to ensure the dementia training for staff by POC due date, 03/21/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
Cynthia TamayoTELEPHONE: (916) 225-3582

DATE: 02/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2025

LIC809 (FAS) - (06/04)
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