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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700073
Report Date: 12/20/2021
Date Signed: 12/20/2021 05:00:24 PM

Document Has Been Signed on 12/20/2021 05:00 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:PEOPLE'S CARE WINFINFACILITY NUMBER:
342700073
ADMINISTRATOR:NARITIA COLLINSFACILITY TYPE:
735
ADDRESS:3418 WINFIN WAYTELEPHONE:
(916) 480-9660
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 4CENSUS: 4DATE:
12/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Tracy Osifo, Director Support Personnel TIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a 10-day complaint inspection. LPA met with Tracy Osifo, Direct Support Personnel/Lead DSP, and explained purpose of inspection. LPA spoke to the Administrator by phone who indicated she was currently at an appointment and arrived at 4:10 pm. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols, confirmed there are currently no positive Covid-19 diagnoses, and completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. The facility is a licensed level 4 home that is vendorized through Alta California Regional Center. LPA observed one client in the common areas at the start of the inspection and the remaining (3) clients to be in their rooms at the start of the inspection. LPA observed (3) DSP's and (1) nurse on shift during the inspection.

LPA and lead DSP toured the interior of the facility, including client bedrooms (4), bathrooms (3), laundry/garage, locked medication area, kitchen and common areas and observed the home to be clean, safe and in good repair and to not pose a health and safety risk or personal rights violation. LPA observed various Covid posters posted throughout the facility. Inside temperature was observed to be 70* F. Fire extinguisher last serviced 11/30/2021. LPA observed sufficient 2+day perishable/7+day non-perishable food. LPA observed locked sharps in the kitchen and toxins in the laundry room. Staff will assist clients with hand-washing and provides soap, sanitizer, and paper towels, when needed, due to (1) client who may ingest materials if accessible. Facility to post 12-steps to hand-washing in all bathrooms. LPA observed documentation of daily temperature checks for residents/staff in a binder. Staff/Client vaccination status was recently discussed with Administrator as well as visitor protocols currently in place per PIN 21-40 issued 8/27/2021. LPA observed signage with visitor protocols, effective 8/9/2021, posted near the front entrance.

LPA requested an updated copy of LIC308 during today's inspection by 12/27/2021. There were no deficiencies observed during today's inspection. Exit interview. Copy of report provided to Administrator who was informed that a subsequent annual inspection could be conducted on/around 2/7/2022.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2021
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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