<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003507
Report Date: 08/28/2023
Date Signed: 08/28/2023 04:16:51 PM


Document Has Been Signed on 08/28/2023 04:16 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: 5DATE:
08/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Lea VicioTIME COMPLETED:
04:30 PM
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
Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required visit. LPA arrived at 1:12PM but no one was home. According to Administrator Lea, the residents are at day program and staff would be back at 2:30 PM. LPA later arrived at 3:10PM to complete the visit. LPA met with Administrator Lea Vicio, and explained the purpose of the visit.

LPA and facility staff Peter toured the facility to ensure compliance with Title 22 regulations. LPA observed 4 resident bedrooms, 2 bathrooms, common areas, and dinning area. Bedrooms were furnished, clean, and free from debris. Bathrooms were fully stocked with paper towels, soap, trash cans, handrails, and hand sanitizer. Medication, cleaning supplies, and sharps were observed to locked and inaccessible to residents in care. Facility temperature was observed to be 75*degrees F. Hot water in the bathrooms were measured at 110.0*degrees F. Facility has nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. No emergency exits were obstructed. The backyard was observed to be free from debris and had an area for outdoor activities. LPA observed residents listening to music, watching television, doing arts and crafts, walking around the house, and getting settled in from Day Program.

LPA spoke to residents and staff during the visit. LPA reviewed staff and resident files. Files were observed to be current and complete.

LPA requested the following documentation be sent to LPA by 09/01/23: LIC 500, LIC 308, LIC 610, Liability Insurance, Surety Bond

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed or cited. An exit interview was 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: 08/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1