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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700747
Report Date: 02/11/2023
Date Signed: 02/11/2023 02:39:26 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/11/2023 02:39 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:VEA'S CARE HOMEFACILITY NUMBER:
392700747
ADMINISTRATOR:FHARELL, MICHAELFACILITY TYPE:
735
ADDRESS:2232 S SACRAMENTO STTELEPHONE:
(209) 662-5783
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY: 6CENSUS: 4DATE:
02/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:34 PM
MET WITH:Josie VeaTIME COMPLETED:
02:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection. LPA met with Josie Vea and explained the purpose of the visit. There are four residents in care at this time.

LPA inspected the physical plant. LPA observed sufficient furniture and lighting throughout the facility. Hot water temperature was measured at 110 degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees. During the tour of the facility LPA observed a sleeping area for Staff, the area was cleared and the Licensee stated that they are working on plans to have a room added onto the garage with permits. (Advisory Given)

Fire extinguishers and smoke detectors are operational. LPA observed centrally stored medications unlocked in residents room. During the file review LPA observed an expired Individual Program Plans for R1 and R2 both are expired as of 12/2021 and 2/2021. LPA was not able to determine the number of hours completed for orientation for S1 and S2. Fire drill was conducted on 2/3/2023.

First aid kit was checked and is complete. LPA observed carbon monoxide detectors in the facility.

Deficiencies were observed and cited on the attached 809D page. Advisories given Exit interview conducted.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2023
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 2
Document Has Been Signed on 02/11/2023 02:39 PM - It Cannot Be Edited


Created By: Albert Johnson On 02/11/2023 at 01:43 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: VEA'S CARE HOME
FACILITY NUMBER: 392700747

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2023
Section Cited
CCR
80068.2(b)(1)

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The needs appraisal or IPP is not more than one year old. LPA observed R1 and R2 IPP's to be more than 1 year old. Additionally, IPP stated that identified consumer is on an annual review. The regional center has been made aware of the outdated IPP's and have not sent the requested documents to date.
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Facility to obtain a current IPP, not more than a year old. Facility will furnish LPA with a current, recent IPP for the identified individual. By the POC date. Additionally all residents files will be reviewed to update quarterly report for each ISP.
Type B
02/28/2023
Section Cited
CCR
80065(f)(b)

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All personnel shall be given on-the-job training or shall have related experience which provides knowledge of and skill in the following areas, as appropriate to the job assigned and as evidenced by safe and effective job performance.
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The program shall submit a staff orientation/ in-service training schedule, including training curriculum and names of staff attended. by POC date
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 LPA was not able to determine the number of hours completed for orientation for S1 and S2. This is a potential safety concern
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Stephenie Doub
LICENSING EVALUATOR NAME:Albert Johnson
LICENSING EVALUATOR SIGNATURE:
DATE: 02/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/11/2023


LIC809 (FAS) - (06/04)
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