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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004650
Report Date: 04/13/2023
Date Signed: 04/13/2023 04:45:59 PM

Document Has Been Signed on 04/13/2023 04:45 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
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:BUENA VISTA HOME IIFACILITY NUMBER:
347004650
ADMINISTRATOR:ASTRONOMO, REYFACILITY TYPE:
735
ADDRESS:6350 MARIPOSA AVENUETELEPHONE:
(916) 727-7273
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 4CENSUS: 4DATE:
04/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Melody Bulanadi, Co-Administrator/caregiver TIME COMPLETED:
04:45 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) Sabrina Calzada arrived unannounced to conduct a required annual inspection. LPA met with Analiza Dalanan, caregiver and Melody Bulanadi, Co-Administrator/caregiver, and explained purpose of inspection. Also present was Edgar Bulanadi, staff. LPA was advised that Administrator, Rey Astronomo, was currently out of the facility. The facility is a level 4--I home, vendorized by Alta California Regional Center, and is licensed for (4) clients. LPA observed (1) client present at the start of the inspection and (3) clients return from Day Program at the end of the inspection. LPA completed the required COVID-19 Department protocols and was wearing a surgical mask.

LPA and Co-Administrator toured the interior and exterior of the facility including the common areas, (4) private resident bedrooms, (1) staff room, (2) resident bathrooms, kitchen, laundry area and garage. LPA observed the facility to be clean, in good repair and odor-free. LPA observed each bathroom to have the necessary grab bars, non-skid flooring, paper towels, trash can with lids and 20-second hand-washing poster. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food and sharps, toxins and medications to be locked in the kitchen. LPA observed additional food in the garage. The inside temperature measured 69*F, and the water temperature measured 105*F in the kitchen. Discussed vaccination status of residents/staff. LPA observed (1) unlocked gate from the inside back patio and outdoor area with seating. LPA reviewed (2) of (4) client files and found them to contain current documentation. LPA reviewed P&I funds for client (C1) and ordered medications to those being administered for client (C2) and found no errors. LPA reviewed (1) staff file and found it to contain required paperwork. All staff are cleared and associated to the facility. LPA observed required postings to be posted , including several Covid posters. There is a complete First Aid Kit on site and sufficient PPE supply. LPA reviewed/approved the Infection Control Plan (19 pgs) which was found to be comprehensive and observed related training documentation from July 2022. Administrator to ensure the Emergency Disaster Plan (LIC610D) is reviewed annually (reviewed Feb 2022) and updated if needed. LPA requested that an updated copy of the LIC308. LIC500 be sent to CCLD by 4/20/23. There are no citations issued during today's inspection; however, there is a Technical Violation being issued. Exit interview. Copy of report e-mailed to Administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2023
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