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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701233
Report Date: 06/12/2023
Date Signed: 06/12/2023 08:51:22 AM


Document Has Been Signed on 06/12/2023 08:51 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:VILLAS ONE INC., THEFACILITY NUMBER:
342701233
ADMINISTRATOR:VILLAVERT, CHRISTOPHERFACILITY TYPE:
735
ADDRESS:8324 CUTLER WAYTELEPHONE:
(916) 606-6673
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:4CENSUS: 0DATE:
06/12/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Christopher Villavert and Julie Villavert TIME COMPLETED:
09:00 AM
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On June 12, 2023, at 8:00 AM, Licensing Program Analyst (LPA) Pang Lee arrived announced to conduct a Pre-Licensing Inspection of the facility to ensure compliance with Title 22 regulations. LPA Lee met with Christopher Villavert and Julie Villavert who assisted LPA in today’s inspection.

Facility has a fire clearance for three ambulatory clients and one non-ambulatory client. The Licensee will be the Administrator of this facility. The Administrator hold a current certificate # 6049862735 and expires on 02/04/2025.

LPA Lee inspected the interior and the exterior of the facility including the common living spaces, client bedrooms and bathrooms, and kitchen. The facility kitchen and client bathrooms were in good repair and furnished. The facility has the required posting throughout the facility, and facility files were completed. The client bedrooms were furnished, and sanitary, and the facility sketch reflects clients’ bedrooms and staff area. LPA Lee observed room 4 for one non-ambulatory client room did have a ramp installed. LPA Lee observed bathroom 1 and the kitchen garage was replaced with a garbage with a fitted lid. LPA Lee also measured the water and it measured at 115.2 which is within the regulations of 108-120 degrees Fahrenheit. The facility fire extinguisher, smoke detectors, and carbon detectors were in good repair. The facility emergency exit gate was in good repair. The facility has a first aid kit and it was complete. The facility has a locked medication cabinet for clients. The facility laundry room is secured. The exterior of the facility was sanitary, and the facility has a shaded patio area for clients. The facility liability insurance document and surety bound document were submitted to the Department. Applicant was advised If any changes in plan of operation occur during the Alta Regional Center vendorization process, they will need to submit the updated plan of operation, which will also need to be reviewed and approved by the Department.

The applicant has passed the pre-licensing component of the application process. LPA Lee will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed. An exit interview was conducted, and a copy of this report was provided to the Applicant.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2023
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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