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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700858
Report Date: 10/02/2023
Date Signed: 10/02/2023 02:28:52 PM

Document Has Been Signed on 10/02/2023 02:28 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:VIBRANT LIVING CARE HOMESFACILITY NUMBER:
392700858
ADMINISTRATOR:SADORRA, JAMESFACILITY TYPE:
735
ADDRESS:3115 ZACCARIA WAYTELEPHONE:
(209) 395-3280
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY: 4CENSUS: 4DATE:
10/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Angelica Carbonel and Jeanette Del RosairoTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual inspection on 10/02/2023 at 1:00 PM. LPA Martinez met with Angelica Carbonel and Jeanette Del Rosairo and stated the purpose of today’s visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations.

Administrator holds current certificate expires on 06/20/2024. The facility is licensed for 2 non-ambulatory clients and 2 ambulatory clients. There are currently 4 residents who reside at this facility.

LPA Martinez toured the facility with Angelica Carbonell on 10/02/2023 at 2:00 PM.

The facility is sanitary and furnished. All common areas, client bedrooms, and client bathrooms are clean and furnished. The facility has an adequate food supply and has an emergency food and water kit. The water temperature measured at 105 degrees, and the facility temperature measured at 74 degrees. The facility smoke detectors, carbon detectors, and fire extinguisher were in good repair. The facility last fire drill was last week. The facility exterior emergency gate is in good repair. The exterior client patio is furnished and in good repair.

LPA Martinez reviewed four staff files and 4 employee files. The facility files were complete and maintained. LPA Martinez reviewed one client P&I file. The P&I file was maintained, and the facility has a surety bond. LPA Martinez reviewed one client medication administration record (MAR). The MAR was maintained. In addition, the facility has a first aid kit.

As a result of this annual visit, the facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code. There were no deficiencies cited at this time, and an exit interview was conducted. Moreover, a copy of this report was provided to the facility at the end of the visit.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2023
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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