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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700801
Report Date: 01/22/2025
Date Signed: 01/22/2025 02:35:37 PM

Document Has Been Signed on 01/22/2025 02:35 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:MINNESOTA HOME CAREFACILITY NUMBER:
342700801
ADMINISTRATOR/
DIRECTOR:
OKYERE, VERA A.FACILITY TYPE:
740
ADDRESS:7448 MINNESOTA DR.TELEPHONE:
(916) 729-9461
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 4DATE:
01/22/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH:Vera Okyere, Administrator TIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met with the Administrator, Vera Okyere. Also present was care staff, Charles Zabay. LPA observed (2) residents in the common area and (2) residents to be in their room at the start of the inspection. LPA observed a Physical Therapist arrive to meet with one of the residents and then an Occupational Therapist arrive to meet with another resident.

LPA and Administrator toured the interior/exterior of the facility including the common areas, (4) private resident bedrooms (1) shared resident bedroom, (2) resident bathrooms, kitchen, activity room, staff room and laundry/storage area. LPA observed the facility to be clean, in good repair and odor-free, and the bathrooms to have the necessary grab bars, non-skid flooring, paper towels. The Administrator will post 20-second hand-washing posters at each sink. There is sufficient 2+day perishable, including fresh produce and 7+day non-perishable supply of food, Sharps and medications are locked in the kitchen and toxins are secured in the laundry area. Inside temperature measured 72*F. Hot water measured 108*F in a resident bathroom. There is signage in the kitchen cautioning staff the hot water temperature is 125*F or hotter. There is sufficient linen, blankets and incontinent/ PPE supplies. There is (1) unlocked gate outside, screens are in good condition and there is an abundant back yard space. Required postings are up.

LPA reviewed (2) resident files and (4) staff files. All files were organized and contain current documentation. Medications were reviewed for (1) resident- there were no errors found and the documentation is complete. All staff are cleared/associated and are completing the required annual training. New staff are in the process of completing the required initial training. All staff have current First Aid/CPR. The Infection Control Plan (27 pgs) was reviewed/approved. LPA requested updated copy of LIC308, LIC500 and current liability insurance.There are no deficiencies observed. The following (2) Technical Advisory Notes were issued.

Exit interview. Copy of report provided to the Administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
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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