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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286803725
Report Date: 01/06/2022
Date Signed: 01/06/2022 01:48:47 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:VIEWMONT VILLAFACILITY NUMBER:
286803725
ADMINISTRATOR:SIMI, ANGELINAFACILITY TYPE:
740
ADDRESS:3158 BROWNS VALLEY ROADTELEPHONE:
(707) 255-8811
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY:6CENSUS: 6DATE:
01/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Angelina Simi, AdministratorTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Lopez arrived unannounced to conduct an Required- 1 year annual inspection and met with Administrator, Angelina Simi. The annual inspection was focused on the Infection Control procedures and practices. LPA conducted risk assessment with Administrator.

LPA conducted a walk-through of the facility with Administrator. Fire Extinguishers were found to be last charged on July 19, 2021. There was sufficient amount of supply for both perishable and nonperishable foods. Facility smoke detectors and carbon monoxide were found to be functioning properly at the time of the visit.

LPA observed COVID-19 precaution postings. LPA advised facility to take temperature for all staff, visitors and residents coming in to facility. Facility had sign-in sheet with screening questions at facility entrance. Resident's temperatures are taken twice a day and documented. Staff clean and disinfect the facility multiple times daily. Staff have completed training on PPE use but will have staff train on infection prevention, symptoms, transmission. The facility has a supply of PPE including gloves, face shields/goggles, N-95 respirators, surgical masks and disposable gowns. The facility has submitted a COVID-19 Mitigation Plan Report on Epidemic Outbreaks specific to COVID-19 which was reviewed by the California Department of Social Services.

Exit interview conducted with Administrator, Angelina Simi whose signature on this document confirms receipt.

No deficiencies cited during this inspection.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Karen LopezTELEPHONE: (707) 588-5048
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2022
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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