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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700801
Report Date: 12/14/2022
Date Signed: 12/14/2022 01:30:28 PM

Document Has Been Signed on 12/14/2022 01:30 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:MINNESOTA HOME CAREFACILITY NUMBER:
342700801
ADMINISTRATOR:OKYERE, VERA A.FACILITY TYPE:
740
ADDRESS:7448 MINNESOTA DR.TELEPHONE:
(916) 729-9461
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 5DATE:
12/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Vera Okyere, Administrator TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met Mele "Mary" Tonga, caregiver, initially and then Vera Okyere, Administrator, and explained purpose of inspection. LPA observed all (5) residents to be in their rooms at the start of the inspection. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (4). Currently, there are (0) residents on hospice. Prior to initiating today's inspection, LPA completed required COVID-19 Department protocols, wore a surgical mask and was screened per Covid-19 precautionary measures upon entering the facility.

LPA and Administrator toured the interior and exterior of the facility including the common areas, (4) private resident bedrooms (1) shared resident bedroom, (2) resident bathrooms, kitchen, staff room and laundry/storage 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- Administrator to install an electronic paper towel dispenser and will also post hand-washing posters at each sink. LPA to provide additional Covid posters by email. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps and medications in the kitchen. LPA observed locked toxins in the laundry room. LPA observed the inside temperature to be 72*F. LPA observed games/activities on site. Discussed vaccination status of residents/staff and eligibility for boosters. LPA observed a few Covid posters throughout as well as other required postings. LPA observed (1) unlocked gate from the inside back patio. There are no bodies of water or a pool. LPA observed sufficient incontinent and PPE products on hand. Administrator certificate #6044860740--exp 8/14/23 posted. LPA reviewed (1) resident file and observed it to contain required documentation. All staff are cleared/associated and roster was recently updated.

LPA requested an updated copy of LIC500, LIC308 and the current liability insurance by 12/21/22. There are no deficiencies issued during today's inspection.

Exit interview. Copy of report provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2022
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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