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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001904
Report Date: 03/10/2022
Date Signed: 03/10/2022 05:03:18 PM


Document Has Been Signed on 03/10/2022 05:03 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:LP NUNEZ CARE FACILITYFACILITY NUMBER:
347001904
ADMINISTRATOR:NUNEZ, LEONIL D.FACILITY TYPE:
740
ADDRESS:8000 35TH AVENUETELEPHONE:
(916) 386-8332
CITY:SACRAMENTOSTATE: CAZIP CODE:
95824
CAPACITY:4CENSUS: 3DATE:
03/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Lionel NunezTIME COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Anthony Tuck arrived to conduct an unannounced annual/random inspection on 03/10/2022. LPA met with Licensee Lionel Nunez Jr and explained the purpose of the visit.
LPA learned that administrator certificate for both Lionel Nunez and his dad Leonil Nunez are expired and renewals are in pending status. LPA contacted the Administrator Certification Section and verified renewals have been received and in pending status.

This facility is a single story building licensed to serve four (4) ambulatory residents. LPA toured the physical plant including but not limited to two resident bedrooms, two resident bathrooms, garage and backyard area. LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present.

LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 118.5 degrees Fahrenheit in kitchen sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers and smoke detectors are in compliance with fire safety. Fire extinguisher last serviced 10/30/2021. Thermostat was measured at 72 degree Fahrenheit.

LPA observed centrally stored medications and toxins was kept locked and inaccessible to clients. LPA reviewed medication cabinet that was securely locked and sharp knives also securely locked. All disinfectants were also secured and inaccessible to clients. LPA reviewed staff associations to the facility. First aid kit was checked and is complete.
The following forms need updating and submitted to CCLD by 03/21/2021:
certificate of liability insurance

Per California Code of Regulations, Title 22 Division 6, Chapter 8, Type A deficiency is being cited today in violation of California Code of Regulations and follows on 809D. Failure to correct the deficiency may result in Civil Penalties. Exit interview held with and a copy of report given at the conclusion of the visit.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Anthony TuckTELEPHONE: (916) 708-6203
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2022
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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Document Has Been Signed on 03/10/2022 05:03 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833


FACILITY NAME: LP NUNEZ CARE FACILITY
FACILITY NUMBER: 347001904

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87412(a)(13)(B)1
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: (B) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 87355(e). 1. For Certified Administrators, a copy their current and valid Administrative Certification meets this requirement.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 1 account.The Licensee did not ensure that a valid administrator certificate was obtained for renewal. No current certificate since 02/26/2022. Which poses an immediate health, safety risk to persons in care.
POC Due Date: 03/11/2022
Plan of Correction
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Licensee will hire a new administrator for the facility while the completion of a certificate renewal is processed with the CCL administrator application unit. Licensee will provide CCLD with required forms for change of Administrator by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Anthony TuckTELEPHONE: (916) 708-6203
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2022
LIC809 (FAS) - (06/04)
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