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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700858
Report Date: 09/03/2021
Date Signed: 09/03/2021 03:28:44 PM

Document Has Been Signed on 09/03/2021 03:28 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:VIBRANT LIVING CARE HOMESFACILITY NUMBER:
392700858
ADMINISTRATOR:DILLA, CHRISTINEFACILITY TYPE:
735
ADDRESS:3115 ZACCARIA WAYTELEPHONE:
(209) 395-3280
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY: 4CENSUS: 0DATE:
09/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Christine Dilla, AdministratorTIME COMPLETED:
02:00 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
On 09/03/2021 at 8:20 am, Licensing Program Analyst (LPA) T. White spoke with Licensee, Michael Lazaro regarding facility risk assessment questions. Licensee confirmed no staff or clients have experienced symptoms within the last 10 days. At 12:45 pm, LPA T. White arrived unannounced to conduct a required 1-year Annual inspection. LPA met with Administrator, Christine Dilla and Licensee, Michael Lazaro. LPA explained the purpose of today’s inspection. LPA was allowed entry into the facility that is licensed to serve a total capacity of 4 ambulatory clients, which 2 may be non-ambulatory.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature for clients is maintained at 76 degree Fahrenheit. LPA observed hot water temperature measured at 110 and 109.8 degrees F. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. Fire extinguisher was last serviced on March 05, 2021. First aid kit observed to be complete. LPA observed mitigation plan completed. Emergency Disaster Plan completed on 01/11/2021.

LPA observed no clients at the facility. Administrator stated the facility is waiting final exit meeting on September 22, 2021 from VMRC. LPA advised Administrator to contact CCLD once clients are admitted to the facility.

No deficiencies cited during inspection. Exit interview conducted with Administrator and Licensee. A copy of report given.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Treana White
LICENSING EVALUATOR SIGNATURE: DATE: 09/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2021
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