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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004650
Report Date: 03/18/2025
Date Signed: 03/18/2025 05:19:16 PM

Document Has Been Signed on 03/18/2025 05:19 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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:BUENA VISTA HOME IIFACILITY NUMBER:
347004650
ADMINISTRATOR/
DIRECTOR:		ASTRONOMO, REYFACILITY TYPE:
735
ADDRESS:6350 MARIPOSA AVENUETELEPHONE:
(916) 727-7273
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 4CENSUS: 4DATE:
03/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:50 PM
MET WITH:Melody Bulanadi, Co-Administrator/caregiverTIME VISIT/
INSPECTION COMPLETED:
05:20 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection. LPA met with Melody Bulanadi, Co-Administrator/caregiver, and stated the reason for today's inspection. LPA observed (2) clients watching television in the common area and was advised (2) clients were resting in their rooms. The facility is a level 4--I home, vendorized by Alta California Regional Center, and is licensed for (4) clients. Sherinine Juanviaje, Administrator Designee, arrived around 4:30 pm.

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. Each bathroom has the necessary grab bars, shower chair, 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. There is additional food/supplies in the garage. The inside temperature measured 70*F, and the hot water measured 108*F in the kitchen. The fire extinguisher was last serviced 8/16/24. There is (1) unlocked exit gate and outdoor seating area. There is not a pool.

LPA reviewed (2) of (4) client files and found them to contain current documentation. LPA reviewed P&I funds and records for (2) clients. Ledger documentation is maintained and funds matched. Medications were reviewed for (1) client- orders match medications being administered and documentation is current. Clients are residing in the appropriate room per the fire clearance.

LPA reviewed (6) staff files which were available for review at the facility. Files were organized and contained required paperwork. All staff completed annual training in Aug/Sept 2024 and CPR/First Aid is valid thru Oct 2025. All staff are cleared and associated to the facility.

LPA requested an updated copy of the LIC308, LIC500 and Surety bond documentation be sent to CCLD by 3/25/25. Exit interview. There are no citations issued during today's inspection.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2025
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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