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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700858
Report Date: 09/07/2022
Date Signed: 09/07/2022 11:17:23 AM

Document Has Been Signed on 09/07/2022 11:17 AM - 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: 4DATE:
09/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:James Sadorra, AdministratorTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Renee Campbell and Michael Bilger conducted an unannounced Case Management visit at Vibrant Living Care Home on 9/7/22 at 10:00 am to address concerns regarding resident who bit staff on 07/07/2022. LPA Campbell met with Administrator, James Sadorra and together discussed the incident that occurred on 07/07/2022 with R1.

The department conducted interviews with Administrator. The Department also conducted review of resident file including incident reports dated 07/07/22, IPP records dated 07/21/2021. Physician’s report (LIC 602) dated 07/02/2022.

Based on the interviews and documents obtained during the investigation process, the department has determined the facility had R1 reassessed. His medication dosage was increased and R1 was able to sleep through the night and has acclimated to his new living situation. No futher incidents of biting occurred since 07/07/2022.

No citations. Exit interview conducted. Appeal Rights and a copy of this report provided.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2022
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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