275202817-11-1-2021-26-AS-ABUI-C8CL8U-20211101083228

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 275202817
Report Date: 10/29/2021
Date Signed: 11/01/2021 08:32:38 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME:	VISTA HARDEN RANCH		FACILITY NUMBER:	275202817
ADMINISTRATOR:	CARTER, JOY		FACILITY TYPE:	740
ADDRESS:	290 REGENCY CIRCLE		TELEPHONE:	(805) 319-7370
CITY:	SALINAS	STATE: CA	ZIP CODE:	93906
CAPACITY:	83	CENSUS: 59	DATE:	10/29/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:38 AM
MET WITH:	Joy Carter		TIME COMPLETED:	02:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 10/29/2021 at 10:38 am, Licensing Program Analyst (LPA) Anna Bui conducted an unannounced pre-licensing inspection for a change of ownership. LPA met with Joy Carter, Administrator. Facility has a fire clearance that is approved for 61 nonambulatory and 22 bedridden residents. Facility currently has 59 residents. During today’s visit, LPA toured the facility inside and out. The facility is equipped with smoke and carbon monoxide detectors. Fire extinguishers were observed in the facility, which were all serviced on 06/31/2021. The kitchen, dining, and living room were observed in good repair. Residents bedrooms were observed in good repair, furnished, with clean linens and adequate lighting. Bathrooms were equipped with grab bars, nonskid floors in the shower, and pull chords. The water temperature in 7 resident’s bathrooms measured between 107.4 – 114.3 degrees Fahrenheit. 2 days of perishable and 7 days of non-perishable food were observed in the kitchen. Refrigerator temperature was maintained at 32 degrees Fahrenheit and freezer temperature was maintained at 0 degrees Fahrenheit. The water temperature in the kitchen was measured at 105.4 degrees Fahrenheit. All outdoor and indoor passageways were observed clear and free of obstruction. No bodies of water were observed. Centrally stored medication cabinet were observed locked. First aid kit was available with sterile dressing, bandages, thermometer, scissors, tweezers, and first aid manual. -Continued, see LIC 809-C.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Anna Bui	TELEPHONE: 650-269-7419
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: VISTA HARDEN RANCH	FACILITY NUMBER: 275202817
	VISIT DATE: 10/29/2021

NARRATIVE

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LPA reviewed 5 resident files and 5 staff files. Facility staff are fingerprint cleared and associated to the facility. Resident files had Admission Agreement, Appraisal Needs and Services Plans, and Functional Capability Assessment forms.

COMP III is waived, as Joy Carter, Administrator, has been an Administrator for 17 years and has already received COMP III orientation.

No issues were noted during this Pre-Licensing inspection. LPA observed the facility is ready to be licensed. However, this report will be submitted to the Central Applications Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be needed.

This report was reviewed with Joy Carter, Administrator, and a copy was provided.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Anna Bui	TELEPHONE: 650-269-7419
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021

LIC809 (FAS) - (06/04)

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