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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701106
Report Date: 02/17/2023
Date Signed: 02/17/2023 12:11:58 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/17/2023 12:11 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: 4DATE:
02/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lupita YepizTIME COMPLETED:
11:30 AM
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On 2/17/23 at approximately 10am Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a required 1 year visit. LPA Maja Jensen met with Licensee Lupita Yepiz and explained the purpose of today's visit.

LPA Jensen toured the grounds and interior including the kitchen, 4 bedrooms, 2 bathrooms, laundry room and garage. The facility was observed to sanitary and free of odor. The fire extinguisher was last serviced in November 2022 and is in compliance. The fire extinguisher and carbon monoxide detector were tested and found to be in working order. The first aid kit was observed to be complete with scissors, tweezers, thermometer and first aid manual. All chemicals, sharp objects and medications were observed to be locked and inaccessible to residents in care. The emergency disaster plan was posted and updated within the last year.

The thermostat was set at 70 degrees for the comfort of the residents in care. The water temperature in the master bathroom was within the required regulatory range of 105-120 degrees. There was a variety of activities available for resident engagement. LPA Jensen observed adequate lighting throughout the facility and night lights in the hallway. All resident bedrooms were equipped with night stand, dresser, lamp and chair. The facility keeps an adequate supply of linens and and PPE on hand.

LPA Jensen observed in excess of a 2 day supply of perishable food and a 7 day supply of non-perishable food. All food is labeled and no expired food was observed. There is fresh fruit including apples, oranges, bananas and packaged snacks easily accessible by the residents.

Continued on LIC 809C....
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2023
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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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: 02/17/2023
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Continued from LIC 809....

LPA Jensen toured the grounds. The grounds were observed to be free of debris and all paths were clear of obstruction. There are no bodies of water on the property. LPA Jensen observed sufficient outdoor furniture for resident activities.

LPA Jensen reviewed 2 of 4 resident files and found them to be complete. LPA Jensen reviewed 2 of 6 staff files and found them to be complete.

LPA Jensen obtained a copy a copy of the current liability insurance and an updated LIC 500.

LPA Jensen observed the facility have COVID mitigation signs posted throughout, 2 copies of resident rights posters, employee rights and an updated resident roster. The Administrator holds a current Administrators certificate # 6040451735 good through 6/1/2024.

The facility was found to be in substantial compliance.

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

DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023
LIC809 (FAS) - (06/04)
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