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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700067
Report Date: 11/10/2021
Date Signed: 11/10/2021 03:55:40 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:HOSPITALITY HOUSEFACILITY NUMBER:
342700067
ADMINISTRATOR:LORRAINE PADILLAFACILITY TYPE:
740
ADDRESS:5400 KIERNAN AVENUETELEPHONE:
(209) 543-9275
CITY:SALIDASTATE: CAZIP CODE:
95368
CAPACITY:80CENSUS: 57DATE:
11/10/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Lorraine Padilla, AdministratorTIME COMPLETED:
04:00 PM
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Licensing Program Manager (LPM) Stephenie Doub and Licensing Program Analyst (LPA) Sarah Hurt made an unannounced visit on this day for the purpose of conducting a case management visit. LPM and LPA met with Administrator (AD) Lorraine Padilla and explained the reason for the visit.

On this day LPM and LPA, toured the facility and spoke to six random residents. During the visit 4 of the 6 residents expressed concerns regarding the food, stating it was inedible, cold and served late. Residents stated that they wait up to an hour for their meals, specifically lunch and dinner. LPA and LPM observed lunch service, which was served timely. It was observed that multiple residents ate less than half of their served meal. When asked why they did not complete their meal they expressed it did not taste good, saying "Here, you eat it."

LPM and LPA also asked about activities. Residents stated the only activity was BINGO. Residents stated there were little other activities in which they wanted to engage. The activity calendar was observed. LPA and LPM asked residents about the activities listed for the day and residents stated they were not aware of those activities taking place.

The following advisory notes were provided on this day. An exit interview was conducted with AD Padilla and a copy of this report along with advisory notes were provided.
SUPERVISOR'S NAME: Krystall MooreTELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021
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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