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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920253
Report Date: 02/18/2025
Date Signed: 02/18/2025 03:16:43 PM

Document Has Been Signed on 02/18/2025 03:16 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:HARMONY HAVEN CARE HOMEFACILITY NUMBER:
345920253
ADMINISTRATOR/
DIRECTOR:
BAXTER, STEPHANIE GAILFACILITY TYPE:
740
ADDRESS:7974 COBB STTELEPHONE:
(530) 965-1600
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 0DATE:
02/18/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:06 PM
MET WITH:Stephanie Baxter, Administrator TIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived announced for a scheduled pre-licensing inspection and met with Administrator, Stephanie Baxter and Myles Baxter, member. There is a pending RCFE 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 Administrator toured the interior and exterior of the facility including the common areas, (2) private resident bedrooms, (2) shared resident bedrooms, (2) resident bathrooms, kitchen, laundry and garage. 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, and a 20- second hand-washing poster. LPA observed 7+ day non-perishable food, and sufficient dishes, flatware and cooking pans in the kitchen. Sharps will be locked in the kitchen. There is a medication cabinet with a lock in the kitchen. All toxins will be locked in the laundry room. Hot water measured 110*F in the kitchen and the inside temperature measured 72*F. Fire extinguishers were last serviced on 1/9/25, and the smoke/monoxide alarms are in working order. There is a complete First Aid kit, paper supplies, and sufficient linens/towels/blankets. There are flashlights and night lights on hand. All resident rooms have the required furniture. There are various required postings visible in the common area, including the Theft & Loss Policy. There is one unlocked exit gate in the backyard, and a table/chairs on the patio. All exit doors have auditory alerts, and there are ramps at the front/back exits. There are activities and reading materials in the common area. LPA reviewed a sample resident file and staff file. Both files contained the required forms.
Administrator to add a visitor sign-in area with visiting hours. Component III was reviewed during today’s inspection.

Pre-Licensing is complete and this facility has no deficiencies. LPA to notify the analyst in Centralized Applications Bureau.
Exit interview. Copy of report left at facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
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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