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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880671
Report Date: 07/06/2022
Date Signed: 07/06/2022 11:17:13 AM


Document Has Been Signed on 07/06/2022 11:17 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507



FACILITY NAME:ACCURO HOMES IIFACILITY NUMBER:
331880671
ADMINISTRATOR:VANNOY, LESLEY SIHAVONGFACILITY TYPE:
740
ADDRESS:13172 EARLY CRIMSON STTELEPHONE:
(951) 817-4598
CITY:EASTVALESTATE: CAZIP CODE:
92880
CAPACITY:6CENSUS: 6DATE:
07/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Lesley Vannoy, Administrator/LicenseeTIME COMPLETED:
11:30 AM
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Licensing Program Analysts (LPA) Amy Goldenberg made an unannounced visit to the facility to conduct an annual inspection with an emphasis on infection control. LPA arrived and observed a hand sanitation and sign in station at the entry of the facility. LPA's temperature was measured upon arrival. LPA learned there are six (6) residents residing in the home at this time. There are no cases of COVID-19 within the facility.

The facility has a mitigation plan in place which follows Community Care Licensing guidelines. LPA conducted a brief tour of the facility and made observations pertaining to the facility's infection control measures. The facility was equipped with sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions, and has a limited supply of Personal Protective Equipment (PPE). LPA discussed the availability of additional PPE supplies to the facility at the time of this visit and advised the facility representatives to contact our office in the event additional supplies are necessary. LPA provided the facility with two boxes of N95 masks during this visit.

Based on the observations made during today’s visit, there are no deficiencies being cited per Title 22, Division 6, of the California Code or Regulations. An exit interview to review this report was conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amy GoldenbergTELEPHONE: (951) 201-3990
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2022
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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