<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700070
Report Date: 10/21/2022
Date Signed: 10/21/2022 03:42:18 PM

Document Has Been Signed on 10/21/2022 03:42 PM - 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:KIND CONNECTIONFACILITY NUMBER:
342700070
ADMINISTRATOR:DELA PAZ, MA. LOURDESFACILITY TYPE:
740
ADDRESS:8159 WACHTEL WAYTELEPHONE:
(916) 599-0477
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 4DATE:
10/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Maria Lourdes de la Paz, Administrator TIME COMPLETED:
03:45 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
Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct an annual inspection and met with caregivers, Richard Dumol and Angelita Lintingco. Caregiver, Josephine Lopez, was starting her shift at the start of the inspection. LPA met with Administrator Lourdes Dela Paz, who arrived at approximately 2:20 pm. The facility is a specialized RCFE facility vendorized through Alta California Regional Center, licensed for (4) non-ambulatory residents, (2) of which can be bedridden. There are currently (4) residents. Administrator requested information about how to obtain a hospice waiver if needed at some point. Prior to today's inspection, LPA completed the required Covid protocols, applied hand sanitizer and was wearing a surgical mask before entering the facility. Additionally, LPA was screened by staff upon entering the facility.

LPA and toured the Administrator toured the interior and exterior of the facility including the common areas, (4) resident bedrooms (2.5) bathrooms, kitchen, staff room and laundry area and garage.. LPA observed the facility to be clean, organized, in good repair and odor-free. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and 20-second hand-washing posters. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps and toxins in the kitchen and additional toxins and medications to be locked. LPA observed the inside temperature to be 71*F. Fire extinguisher was last serviced 7/12/2022 and facility conducts monthly fire drills. Discussed vaccination status of residents/staff, eligibility for boosters and observed binders with verification of staff and resident vaccination status. Booster flyers provided. LPA observed Mitigation Plan, Infection Control Plan and Monkey Pox Plan in binders along with other Covid resources and Department PIN's. Clients to resume attending day program in November 2022. Currently, music and recreational therapists come in. RCFE Admin Cert #6041507740- exp 7/12/24 posted. LPA obtained an updated copy of LIC308, LIC500 and liability insurance. Administrator to email Monkey Pox Plan and Addendum. LPA brought (4) individual bottles of sanitizer.
There were no deficiencies cited.
Exit interview. Copy of report provided to Administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1