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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 270708716
Report Date: 07/11/2024
Date Signed: 07/11/2024 01:32:06 PM


Document Has Been Signed on 07/11/2024 01:32 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, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:VISIONARY CARMEL-BY-THE-SEA ASSISTED LIVINGFACILITY NUMBER:
270708716
ADMINISTRATOR:CONNERS, MARGARET P.FACILITY TYPE:
740
ADDRESS:LINCOLN & 7TH STREETTELEPHONE:
(831) 644-9246
CITY:CARMELSTATE: CAZIP CODE:
93921
CAPACITY:10CENSUS: 5DATE:
07/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Julie ConnersTIME COMPLETED:
01:50 PM
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On 7/11/24, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA introduced self, stated purpose of visit, and allowed entrance by direct care staff. Licensee, Julie Conners contacted by telephone and arrived a short time later to conduct facility tour with LPA.

Facility tour conducted with Licensee. Facility observed to be a comfortable temperature, clean, and well lit. All common areas have adequate seating for residents. Facility has ten (10) private bedrooms. Currently, there are (5) residents in care. All bedrooms observed to have all required accommodations for residents. Resident bathrooms toured, all bathrooms observed to have grab bars, shower chairs and non-skid mats available. Water temperature observed to be 120 degrees. Kitchen toured, LPA observed all sharps are locked and secured. Facility observed to have a 2-day supply of perishable food and a 7-day supply of non-perishable food available. LPA observed medications to be locked and secured in cabinet near kitchen. All chemicals observed to be locked under kitchen sink and additional supplies are in a cabinet in the laundry room.

Outside of facility toured. All exits open free of obstruction. Seating area available for residents. No hazards observed.

Fire extinguisher present with a service date of 9/06/23. Facility is equipped with sprinkler system and pull stations. Smoke and Carbon Monoxide detectors observed operational during inspection. Last fire drill conducted in April 2024 according to facility records.

LPA reviewed resident and staff files. LPA requested the following forms to be submitted to Fresno Regional Office no later than 7/19/24: Personnel Report (LIC 500), Client Roster (LIC 9020), and copy of current liability insurance.

No deficiencies were cited during this inspection. Exit interview was conducted and a copy of this report will be emailed to facility.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2024
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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