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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920231
Report Date: 03/19/2025
Date Signed: 03/19/2025 03:23:27 PM

Document Has Been Signed on 03/19/2025 03:23 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:CYPRESS ESTATE LIVINGFACILITY NUMBER:
345920231
ADMINISTRATOR/
DIRECTOR:
LITA, JOHN DFACILITY TYPE:
740
ADDRESS:8012 MARIPOSA AVENUETELEPHONE:
(916) 696-8468
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 0DATE:
03/19/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:John Lita, Administrator and Jeanina Lita, Co-Administrator TIME VISIT/
INSPECTION COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived announced to conduct a scheduled pre-licensing inspection. LPA met with John Lita, Administrator and Jeanina Lita, Co-Administrator. There is a pending license for (6) residents, all of whom may be non-ambulatory. There are currently no residents present as this location is not currently licensed.

LPA and Administrators toured the interior and exterior of the facility including the common areas, (2) private resident bedrooms, (2) shared resident bedrooms, (1) resident bathroom, staff room/bathroom, kitchen, laundry and pantry area. LPA observed the facility to be clean, in good repair and to have sufficient furniture and lighting throughout. The bathrooms have the necessary grab bars, non-skid flooring, soap, paper towels. All (4) resident rooms are furnished with the required furniture and have closet space also.

LPA observed 7+ day non-perishable food, and sufficient dishes, flatware and cooking pans in the kitchen. Sharps and medications are locked in the kitchen, and toxins are secured in the laundry room. Hot water measured 113*F in the kitchen and the inside temperature measured 68*F. Fire extinguishers were last serviced on 11/15/24, and the smoke/monoxide alarms are in working order. There is a complete First Aid kit in the kitchen. LPA observed some PPE supplies on hand. There are paper supplies, sufficient linens/towels/blankets. There are flashlights and night lights on hand. There are games/activities and an operating land line. There is a covered patio with a table and chairs and one unlocked exit gate in the backyard. Required postings are posted in the common area.

LPA reviewed (1) resident binder and (1) staff binder. Each binder was organized with tab dividers for the required forms. Cameras have been ordered/received and will be installed soon. Auditory alerts for exit doors have been ordered and will arrive within a week or two.

Pre-Licensing is complete and this facility has no deficiencies. LPA to notify the analyst in the applications bureau.
Exit interview. Copy of report provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2025
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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