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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002861
Report Date: 09/22/2022
Date Signed: 09/22/2022 02:09:13 PM

Document Has Been Signed on 09/22/2022 02:09 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:TELECARE EL VERANOFACILITY NUMBER:
345002861
ADMINISTRATOR:MCDERMOTT, CARISSAFACILITY TYPE:
738
ADDRESS:8736 EL VERANO AVENUETELEPHONE:
(707) 815-7145
CITY:ELVERTASTATE: CAZIP CODE:
95656
CAPACITY: 4CENSUS: 0DATE:
09/22/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:28 PM
MET WITH:Carissa McDermott, Start up AdministratorTIME COMPLETED:
02:29 PM
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On September 22, 2022 at 1pm, Licensing Program Analyst (LPA) De Anna Williams-Lyons arrived announced to conducted an Pre-Licensing Inspection of the facility to ensure compliance with Title 22 regulations. LPA Lyons met with Carissa McDermott, start up Administrator, who assisted LPA in today’s inspection.

Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and a N-95 mask was worn for Personal Protective Equipment.

The Administrator certificate expires 8/29/2024. The current census is 0_. The facilities Administrator’s Certificate, Emergency Disaster Plan, Resident’s Rights and Facility Sketch was available for viewing. The room temperature was 77 degrees F which is within range.

LPA inspected the interior and the exterior of the facility including the common living spaces, the kitchen, resident bedrooms and bathrooms. In the kitchen area, cabinets and drawers were reviewed. Knives and sharp objects were reviewed to make sure that they were locked and made inaccessible to the residents at all times. LPA observed there to be a sufficient amount of 2-day perishable Hot water temperatures were taken and measured at 110 degrees F, which is within the allowed range of 105-120 degrees. There’s appropriate lighting throughout the facility.

To continue see 809-C...

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: TELECARE EL VERANO
FACILITY NUMBER: 345002861
VISIT DATE: 09/22/2022
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The facility is a one story home. Living rooms, dining room, and areas designated for resident use were toured. Furniture and furnishings were observed to be sufficient and in good repair. Resident bedrooms and bathrooms were toured. There are 4 Bedrooms. All rooms had the required items of furniture. Window screens were on and in good repair. Bathrooms were clean, sanitary and odorless and consisted of grab bars and non-skid mats. Hot water temperature is 110 degrees F. The sink, toilet, bathtub and shower operate properly. The facility has a sufficient supply of linens, towels, bedding, etc. for residents in care. Washer and dryer was present and operating properly. Toxic substances, laundry and cleaning supplies are inaccessible.

There’s a centralized storage area for resident’s medication. Medication cabinet was locked. First aid kit was present and included the required scissors, tweezers, thermometer and guide. Fire alarms, smoke alarms, and carbon monoxide detectors operate properly. Fire extinguisher is maintained and ready for emergency use. The facility was observed to have been annually inspected in April 2022 by Fire Code and in compliance at this time. LPA inspected the exterior grounds of this facility. There are no bodies of water on the premises. The perimeter fence, side gates, and latches were in good repair. Passageways are free of obstruction and potential hazards.

The administrator has an updated CPR and First Aid Certificate.

Per California Code of Regulations, Title 22 Division 6, Chapter 8, no deficiencies were observed today



.Licensure pending approval from Central Application Unit

An exit interview was conducted and a copy of this report was given to Carissa.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
LIC809 (FAS) - (06/04)
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