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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002993
Report Date: 03/13/2025
Date Signed: 03/13/2025 02:20:23 PM

Document Has Been Signed on 03/13/2025 02:20 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:MAHALOHA CARE LLCFACILITY NUMBER:
345002993
ADMINISTRATOR/
DIRECTOR:		RIVERA, GERALD JOHN G.FACILITY TYPE:
740
ADDRESS:8223 TWIN OAKS AVETELEPHONE:
(916) 910-9652
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 5DATE:
03/13/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Gerald Rivera, Administrator TIME VISIT/
INSPECTION COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection and met with Sashana Barnett, caregiver, and explained purpose of inspection. Administrator, Gerald Rivera, arrived at 12:00 pm. LPA observed (1) resident in the common area and (4) residents in their rooms at the start of the inspection. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (5). Currently there is (1) resident on hospice.

LPA and the caregiver toured the interior/exterior of the facility including common areas, (1) shared resident bedroom, (4) private resident bedrooms, (2) bathrooms, kitchen, staff room, laundry area and outside patio. LPA observed the facility to be clean, in good repair and odor-free. Bathrooms have the necessary grab bars, non-skid flooring, paper towels, trash can with a lid, and a 20-second hand-washing poster. LPA observed sufficient 2+day perishable food, including fresh produce, and 7+day non-perishable supply of food. Sharps and toxins are locked in the kitchen, and medications are secured nearby. The fire extinguisher was last serviced 1/10/25 and facility will be sure to conduct (2) disaster drills each quarter. Smoke/monoxide alarms are working. Inside temperature measured 73*F. Hot water temp measured 126*F in the kitchen and in a resident bathroom. There is a sign posted at the kitchen sink and additional signs will be posted in the bathroom(s). Water temperature was lowered during the inspection but still measured over 120*F. There are sufficient linens/towels/blankets and PPE. Administrator Certificate #6061379740 - exp 12/26/25. The pool is currently filled with dirt and is gated/locked. Patio seating is covered.

(3) resident files were reviewed. Files are organized and contain current physician's reports and updated care plans. Medications were reviewed for (1) resident- orders matched meds. All staff is cleared/associated. Staff completed required (20) hours annual training in December 2024. Will complete (6) hours of medication training by 3/20/25. At least (1) staff has current CPR and staff to complete First Aid by 3/13/25. Administrator purchased an updated Dementia care plan during today's inspection. Updated copy of insurance obtained. There are no deficiencies. Exit interview. Copy of report provided to Administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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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