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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701106
Report Date: 08/24/2022
Date Signed: 08/24/2022 05:00:41 PM

Document Has Been Signed on 08/24/2022 05:00 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:LA FAMILIA RESIDENCE 2 INC.FACILITY NUMBER:
392701106
ADMINISTRATOR:YEPIZ, GUADALUPE CRYSTALFACILITY TYPE:
735
ADDRESS:570 SANDPIPER CIRTELEPHONE:
(209) 331-9417
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY: 6CENSUS: 1DATE:
08/24/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Guadalupe YepizTIME COMPLETED:
05:00 PM
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On 8/24/22 at approximately 2:40pm Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a post-licensing visit. LPA Jensen met with Licensee Guadalupe Yepiz and explained the purpose of today's visit.

LPA Jensen toured the facility including but not limited to kitchen, dining room, 2 bathrooms, 4 bedrooms, laundry room, garage and grounds.

The facility was observed to be sanitary and free of odor. The grounds were landscaped and free of obstruction. There are no bodies of water on the property. The facility was 77 degrees which falls within the required range of 68-85 degrees. The water temperature in the kitchen was measured at 111 degrees which falls within the required range of 105-120 degrees. The fire extinguisher was last serviced in October of 2021 and is in compliance. The emergency disaster plan was reviewed and is in compliance. LPA Jensen discussed use of the Everbridge Application with Licensee. The facility keeps a supply of PPE in excess of 30 days. Carbon monoxide detectors in the facility were observed to be in good repair. The hallways were equipped with night lights.

There was 2 days of perishable food and 7 days of non-perishable food on hand. Fresh fruit including bananas, melons, and citrus fruit is available and accessible by residents. An adequate supply of linens is available for residents in care. The medications and toxins were observed to be locked and inaccessible to residents.

LPA Jensen interviewed 1 of 1 resident. See LIC 812. LPA Jensen reviewed 1 of 2 staff files and 1 of 1 resident files.
Continued on LIC 809C....
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: LA FAMILIA RESIDENCE 2 INC.
FACILITY NUMBER: 392701106
VISIT DATE: 08/24/2022
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The facility was found to be in substantial compliance with the California Code of Regulations, Title 22, Division 6 and the Health and Safety Code. No deficiencies are being cited as a result of today's visit.

An exit interview was conducted and a copy of this report was given to the licensee.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
LIC809 (FAS) - (06/04)
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