345002861-9-25-2024-59-AS-DAWL-D9FPKD-20240925112257

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 345002861
Report Date: 09/25/2024
Date Signed: 09/25/2024 11:23:47 AM

Document Has Been Signed on 09/25/2024 11:23 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	TELECARE EL VERANO		FACILITY NUMBER:	345002861
ADMINISTRATOR/ DIRECTOR:	MCDERMOTT, CARISSA		FACILITY TYPE:	738
ADDRESS:	8736 EL VERANO AVENUE		TELEPHONE:	(707) 815-7145
CITY:	ELVERTA	STATE: CA	ZIP CODE:	95656
CAPACITY: 4		CENSUS: 2	DATE:	09/25/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:55 AM
MET WITH:	Tyler Glassford, Board Certified Behavioral Analyst		TIME VISIT/ INSPECTION COMPLETED:	11:45 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On September 25, 2024, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to conduct an Annual Inspection. LPA met with Tyler Glassford, Board Certified Behavioral Analyst and informed him the reason for the visit. The current census is 2. The facilities Administrator’s Certificate, Emergency Disaster Plan, Resident’s Rights and Facility Sketch was available for viewing. The room temperature was 71 degrees F which is within range. El Verano Community Crisis Home (CCH) serves adults 18 and over with complex needs who might also have mental health symptoms. LPA toured the exterior and interior of the facility including the common living spaces, resident bedrooms and bathroom and the kitchen. 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 and 7-day non-perishable food. Hot water temperatures were taken and measured at 113 degrees F, which is within the allowed range of 105-120 degrees. There’s appropriate lighting throughout the facility. The facility is a one story, 4 bedrooms, 2 bathroom 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. Bedrooms had all the required furniture. Bathrooms were clean, odorless, and consisted of chairs and non-skit mats. . The sink, toilet, 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 were made inaccessible. To continue see 809-C

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: TELECARE EL VERANO	FACILITY NUMBER: 345002861
	VISIT DATE: 09/25/2024

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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 on April 24, 2024 by Fire Code and in compliance at this time. LPA inspected the exterior grounds of this facility. LPA toured the exterior grounds. 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 There’s a room for resident’s medication. Medication cabinet was locked. The facility Medication Administration Record was reviewed as well as the dispensing log.

LPA reviewed 2 resident files and 2 staff files. Resident's Records reviewed indicated emergency contacts, Assessments, Admission Agreements and Physician's Reports were all current and up to date. Staff records reviewed revealed current First Aid & CPR certificates, Health Screenings and Emergency Contacts were all up to date and the facility is conducting staff training as required.

Tyler and LPA completed the inspection tool with no issues or concerns. No clients to be interviewed.

In the areas that were evaluated, no deficiencies were observed.

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

The administrator shall submit updated copies of the LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610D the Emergency Disaster Plan, and copy of current Liability Insurance to update the facility file in our Regional Office. Administrator shall submit the listed documents to Licensing no later than October 25, 2024.

An exit interview was conducted and a copy was given to Tyler Glassford.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

LIC809 (FAS) - (06/04)

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