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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002861
Report Date: 10/19/2023
Date Signed: 10/19/2023 12:06:10 PM

Document Has Been Signed on 10/19/2023 12:06 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
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: 3DATE:
10/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:59 AM
MET WITH:Michelle Wood, Office ManagerTIME COMPLETED:
12:15 PM
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On October 19, 2023, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to conduct the required Annual Inspection. LPA met with Michelle Wood, and explained the reason for the visit.
LPA and Michelle completed the Infectious Control questionnaire with no concerns or issues.

The current census is 3 . The Emergency Disaster Plan, Resident’s Rights and Facility Sketch was available for viewing and There’s appropriate lighting throughout the facility. The temperature was 70 degrees in the facility. LPA inspected the interior and the exterior of the facility including the common living spaces, bathrooms, and multipurpose room, classrooms and kitchen. Bathrooms were clean and in good repair. Smoke alarms were checked and in good working order. 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 to residents.

There’s a centralized storage area for resident’s medication. Medication cabinet was locked. Client's medical files were up to date and current. First aid kit was present and included the required scissors, tweezers, thermometer and guide. Fire alarms, and carbon monoxide detectors operate properly. Fire extinguisher is maintained ready for emergency use. LPA reviewed 3 residents files and 3 staff files All were in compliance.

Per California Code of Regulations, Title 22, No citations were issued.


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The administrator shall submit updated copies of the LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610E the Emergency Disaster Plan, and copy of your current Liability Insurance to update the facility file in our Regional Office. Administrator shall submit the listed documents to Licensingno later than November 19, 2023.

A copy of this report was given to Michelle Wood.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2023
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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