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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004430
Report Date: 02/10/2023
Date Signed: 02/10/2023 04:50:57 PM

Document Has Been Signed on 02/10/2023 04:50 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:POPO'S PLACEFACILITY NUMBER:
347004430
ADMINISTRATOR:RACHEL MILESFACILITY TYPE:
740
ADDRESS:7672 EASTGATE AVENUETELEPHONE:
(916) 961-6248
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 5DATE:
02/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Retha Micheli, caregiver TIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met with caregiver staff, Retha Micheli, and explained purpose of inspection. LPA spoke to Administrator, Rachel Miles, by phone at the start of the inspection. Rachel stated her manager would meet LPA at the facility. Manager, Kim Rosa, arrived at 2:30 pm.LPA observed (4) residents to be in the common areas and (1) resident to be in her room at the start of the inspection. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (2). Currently, there are (0) residents on hospice. Prior to initiating today's inspection, LPA completed required COVID-19 Department protocols, wore a surgical mask and was screened per Covid-19 precautionary measures upon entering the facility.

LPA and manager toured the interior and exterior of the facility including the common areas, (4) private resident bedrooms (1) shared resident bedroom, (2) resident bathrooms, (1) staff room, kitchen and laundry area, and garage 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, and locked sharps, medications and toxins in the kitchen and locked toxins in the laundry area. LPA observed the inside temperature to be 75*F. All staff are cleared and associated to the facility. Discussed vaccination status of residents/staff. Booster flyer was provided. LPA observed multiple Covid posters throughout as well as other required postings. LPA observed (2) unlocked gates from the outside patio and also covered seating. LPA observed sufficient incontinent and PPE products on hand. Discussed PIN 23-02 issued 2/9/23. LPA observed RCFE Administrator certificate #6001225740-exp 6/1/23. LPA reviewed (2) resident files and (2) staff file and found them to be complete with current documentation, including training, completed through out approved outside vendor.

LPA requested an updated copy of the LIC308, LIC500 and current liability insurance be provided by 2/17.
There are no citations issued during today's inspection. Exit interview. Copy of report provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2023
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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