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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003426
Report Date: 01/13/2023
Date Signed: 01/13/2023 12:10:52 PM


Document Has Been Signed on 01/13/2023 12:10 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:DEL VISTA RESIDENTIAL CAREFACILITY NUMBER:
347003426
ADMINISTRATOR:SAEL, TATY L.T.FACILITY TYPE:
740
ADDRESS:78 DEL VISTA CIRCLETELEPHONE:
(916) 690-7243
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:6CENSUS: 6DATE:
01/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator Taty Sael TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct a annual/required inspection. LPA Lund met with caregiver who contacted the Administrator Taty Sael regarding the purpose of today’s visit. Administrator Taty Sael arrived short time later to assist with today’s visit. Census: 6

LPA Lund & Administrator Taty Sael toured/inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be at 72*F which is within the required range of 68-85*F.

LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, pull alarm system, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents.

The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited during this visit. An exit interview was conducted with Administrator Taty Sael and a copy report was left.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023
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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