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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 095002887
Report Date: 03/24/2022
Date Signed: 03/24/2022 09:50:39 AM


Document Has Been Signed on 03/24/2022 09:50 AM - 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:VISTA HILLS SENIOR CARE INCFACILITY NUMBER:
095002887
ADMINISTRATOR:DHAMI, SONAMJEETFACILITY TYPE:
740
ADDRESS:1660 DOWNIEVILLE CTTELEPHONE:
(650) 740-1680
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:6CENSUS: 0DATE:
03/24/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sonamjeet DhamiTIME COMPLETED:
10:00 AM
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Pre-licensing visit conducted today by Michael Smith LPA and licensee/administrator Sonamjeet Dhami. There are no residents. Facility was granted fire clearance on 1/31/21 for a total of 6 residents, in which 4 can be non-ambulatory, and 2 bedridden seniors. Facility will serve 6 senior residents ages 60 and over. Administrator’s certificate expires on 2/7/24.

Facility was inspected both indoors and outdoors. Outdoors was clean, tidy with adequate shading. Indoors has the requisite rooms for activity/den/dining. There are locked cabinets for personnel and client records. Facility has a First Aid kit and centrally stored locked cabinet for medication. Facility has appropriate linens for the bedrooms and baths. Bedrooms have the appropriate furnishings, chair, adequate lighting and storage. Water faucets are marked hot and cold with the hot water temperature at 117'. Smoke detectors were present. Fire extinguisher indicator revealed a full charge. Toxins and chemicals are appropriately locked in a cabinet. No hazardous debris noted.

All adults ages 18+ who reside here and are not clients, and all staff shall be fingerprinted and pass a criminal background check, prior to being present at the facility.

Licensee completed Component II on 2/15/22.

Licensee is required to contact Community Care Licensing upon the admittance of their first consumer, after licensure.

This report will be forwarded to the centralized application unit for continued processing.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Michael SmithTELEPHONE: (916) 208-7807
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2022
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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