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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001947
Report Date: 11/07/2023
Date Signed: 11/07/2023 04:35:05 PM

Document Has Been Signed on 11/07/2023 04:35 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:EVA'S CARE HOMEFACILITY NUMBER:
347001947
ADMINISTRATOR:NEMETHY, EVAFACILITY TYPE:
740
ADDRESS:8220 CATALPA DRIVETELEPHONE:
(916) 727-1904
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 5DATE:
11/07/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Eva Nemethy, Administrator TIME COMPLETED:
04:35 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to complete the required annual inspection. LPA met with Robert Kovacs, caregiver, who contacted Eva Nemethy, Administrator, and explained the purpose of today's inspection. There are currently (5) residents who reside at the community- (1) resident moved in yesterday. Eva arrived at the facility at approximately 2:30 pm and left at 3:30 pm.

During today's inspection, reviewed medications for (3) of (5) residents. Medications being administered are all prescribed and have orders. The Administrator to ensure all medications are logged on the Centrally Stored Medication Record (LIC622) upon a resident moving in as well as ensuring a record of all medications is provided upon move-in.

A Medication Administration Record (MAR) is provided for some of the residents who are under a specific health care plan. LPA observed the MAR for November 2023 to be completed correctly through today's date.

LPA reviewed paperwork for (2) residents who recently moved in and found it to be complete.
LPA interviewed (2) residents and (1) staff during today's inspection.

LPA re-checked the water temperature in the kitchen which measured 110*F.

There are no deficiencies issued during today's inspection. A Technical Violation is being issued today.

Exit interview with staff, Robert, who is authorized to sign today's report.

Copy of report provided to staff.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2023
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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