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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340310728
Report Date: 12/14/2021
Date Signed: 12/14/2021 11:32:48 AM

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:VINSON'S CARE HOMEFACILITY NUMBER:
340310728
ADMINISTRATOR:VINSON, CALDONIAFACILITY TYPE:
740
ADDRESS:6121 GILMAN WAYTELEPHONE:
(916) 348-4067
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY:6CENSUS: 4DATE:
12/14/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:03 AM
MET WITH:Caldonia Vinson, Administrator/LicenseeTIME COMPLETED:
11:45 AM
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On 12/14/2021, Licensing Program Analyst (LPA) Williams arrived unannounced to conduct a case management visit regarding the legal action pending against Vinson's Care Home, Vinson's Care Home II, and Vinson Care Home III. LPA met with Administrator/Licensee Caldonia Vinson. Prior to entering, LPA completed weekly COVID testing, daily symptom screening, and wore surgical mask. In addition, LPA was screened at entrance door by staff.

LPA viewed notice posted in dining room area (conspicuous location) stating administrative action pending. LPA asked to see notice provided to residents, and Administrator informed that she placed a notice in each of the resident's binders. Administrator showed LPA the notice and it was a handwritten note stating "Administrative action pending" and was dated 12/05/2021. LPA asked if Administrator notified the residents responsible parties, to which Administrator stated she had not, but stated she will do so today following her meetings with ALTA. LPA took down Responsible Party's respective phone numbers to verify that they have been notified later today (12/14).

LPA notified that if the residents respective Responsible Parties have not been notified today, that civil penalties could be assessed.

There are no citations being assessed during visit. Exit interview conducted and a copy of report will be left at facility.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Jacob WilliamsTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021
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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