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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700183
Report Date: 12/05/2024
Date Signed: 12/05/2024 10:18:20 AM

Document Has Been Signed on 12/05/2024 10:18 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MEADOW VISTA HOME AT DURELLOFACILITY NUMBER:
342700183
ADMINISTRATOR/
DIRECTOR:		ASTRONOMO, MARIA SHENICA RFACILITY TYPE:
735
ADDRESS:3420 DURELLO CIRCLETELEPHONE:
(916) 895-1470
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY: 4CENSUS: 4DATE:
12/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Maria Shenica R Astronomo TIME VISIT/
INSPECTION COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required inspection. LPA Valerio met with facility staff, and explained the purpose of the visit. LPA Valerio was later met by Administrator Maria.

LPA Valerio observed 4 residents in care. One resident went to day program, another resident went to a morning appointment, and 2 residents were assisted with activities with staff members. Staff were observed assisting residents, cleaning the facility, and preparing meals. LPA Valerio observed common areas to be clean, fully furnished, and free from debris. Emergency exits were observed to be clear from obstructions. Resident bedrooms were observed to be personalized, fully furnished, and free from odors. Resident bathrooms were observed to be fully stocked with hand soap, hand sanitizer, a trash can, paper towels, and toilet paper. The kitchen was observed to be sanitary with sharps locked away and inaccessible to residents in care. The facility was observed to have an adequate food supply. The exterior area was observed to have an area for outdoor activities and the fence was in good condition. Fire extinguisher, fire pull alarm system, heating and air conditioning, and carbon monoxide detectors were observed to be in working condition. No health or safety concerns observed during today's visit.

LPA Valerio reviewed two (2) resident files and two (2) staff files. Files were observed to be up to date with annual required documentation. The last fire drill was conducted on 11/02/2024.

LPA Valerio requested the following annual documentation be sent to the Regional Office fax line 916-263-4747: LIC 500, LIC 308, LIC 610, and Copy of Surety Bond

Per California Code of Regulations (CCR) - Title 22 - no deficiencies are being cited today. An exit interview was held, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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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