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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700858
Report Date: 09/20/2022
Date Signed: 09/20/2022 11:58:29 AM

Document Has Been Signed on 09/20/2022 11:58 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:
09/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Jeanette Del Rosario - LicenseeTIME COMPLETED:
12:20 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) Ruth Wallace arrived unannounced to conduct a Required 1-year Annual Inspection Visit. LPA met with licensee. 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. 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. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Water temperature reads 113.3*F in the bathroom and room temperature reads 74*F. LPA observed the facility to have adequate food supply. Fire extinguisher was checked 9/20/2022. Facility has an emergency food and water kit. First aid kit observed to be complete. LPA observed mitigation plan completed. Emergency Disaster Plan completed on 01/11/2021. LPA observed the facility to have hand washing, COVID-19 informational, and social distancing signs posted throughout the facility, on the front door, and back yard. The facility has a designated infection control lead. The facility is able to designate and dedicated a COVID-19 room/bathroom if needed. Common touch surfaces are cleaned after each use.

LPA reviewed 2 of 4 resident records. LPA reviewed 4 staff records and all have health screen and TB results. A review of staff records indicates that all facility staff has received criminal record clearances and/or are associated to this facility. Staff records reviewed first aid certificates and staff are current.

Per California Code of Regulations, Title 22, no deficiencies were observed during this visit.

Exit interview was held and a report was given to Licensee.



SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Ruth Wallace
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2022
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