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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003628
Report Date: 10/04/2024
Date Signed: 10/04/2024 02:31:46 PM

Document Has Been Signed on 10/04/2024 02:31 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:SUGAR MAPLE CARE HOMEFACILITY NUMBER:
347003628
ADMINISTRATOR/
DIRECTOR:		SOTEA, FLORICAFACILITY TYPE:
740
ADDRESS:6737 SUGAR MAPLE WAYTELEPHONE:
(916) 222-2022
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 4DATE:
10/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:05 AM
MET WITH:Florica Sotea, Administrator TIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Florica Sotea, Administrator, and Shelley Ann Mc Leod, caregiver, and explained the reason for the inspection. LPA was advised there are (4) residents currently. LPA observed (2) residents watching television in the common area and (2) residents resting in their rooms. The facility has a hospice waiver for (3), and there are (2) residents on hospice currently.

LPA and Administrator toured the interior and exterior of the facility including the common areas, (2) shared resident rooms, (2) private resident rooms, (2) resident bathrooms, kitchen, staff room and garage/locked laundry area. LPA observed the facility to be clean, in good repair and odor-free. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food. There is additional food along with paper/incontinent and PPE supplies in garage area. Toxins are locked in the garage, sharps are locked in the kitchen and medications are locked in a cabinet near the kitchen. All exit doors have alarms and there are mini-ramps at the front entrance, and the patio door. There is (1) unlocked gate outside and covered patio seating. There are no pools or bodies of water. Residents participate in a variety of activities, including painting, cross-word puzzles, music, and singing. Smoke/monoxide alarms are in working order, and the fire extinguisher was last serviced 4/4/24. Quarterly fire drills to be documented.

LPA reviewed (2) resident files and found them to be organized, complete and contain current documentation. Medications were reviewed for (1) resident. Orders match medications being given.
Administrator certificate # 602537174- (exp 5/15/25) is posted in the common area. (3) staff files were reviewed. All staff have current certifications in First Aid/CPR and are in the process of completing annual required training. Documentation is on file. LPA requested an updated copy of LIC500, LIC308 and obtained a copy of the current liability insurance.
There are no deficiencies. A Technical Advisory Note is being issued. Exit interview. Report to be emailed.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2024
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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