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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003507
Report Date: 09/22/2022
Date Signed: 09/22/2022 02:08:28 PM


Document Has Been Signed on 09/22/2022 02:08 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:VICIO CARE HOMEFACILITY NUMBER:
347003507
ADMINISTRATOR:VICIO, LEA M.FACILITY TYPE:
740
ADDRESS:9063 WHARTON WAYTELEPHONE:
(916) 689-8012
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 6DATE:
09/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Lea VicioTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual inspection. LPA Valerio met Administrator Lea, and stated the purpose of today’s visit.
 
The physical plant was toured inside and outside to ensure the safety of the residents and compliance with Title 22 regulations. LPA also conducted the infection control domain tool. LPA observed the facility to have a first aid kit, hand washing signage, and COVID-19 informational signage posted at the front door and throughout the facility.
 
LPA observed the temperature inside the facility was measured at 75 *F, which is within the required range of 68 degrees F and 85 degrees F. The hot water was measured at 116.2 *F. Facility has nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. An emergency supply of food, supply of PPE, and a first aid kit was observed LPA observed the centrally stored medications area to be locked and inaccessible to clients. LPA Valerio observed a pull alarm system, fire extinguisher(s) with last check on 11/05/2021, smoke and carbon monoxide detectors, central heating, and air in the facility.
 
Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed or cited.  Exit interview held with Administrator Lea, and a report was provided.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
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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