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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486802028
Report Date: 06/25/2021
Date Signed: 06/25/2021 12:30:50 PM

Document Has Been Signed on 06/25/2021 12:30 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:PARKVIEW CARE HOMEFACILITY NUMBER:
486802028
ADMINISTRATOR:DIONISIO, LELANDFACILITY TYPE:
740
ADDRESS:1325 POTRERO CIRCLETELEPHONE:
(707) 688-3439
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY: 6CENSUS: 6DATE:
06/25/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:56 AM
MET WITH:Pamela DIonisioTIME COMPLETED:
12:45 PM
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Licensing Program Analysts (LPA) Walters conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility and was greeted by Administrator, Pamela Dionisio (6010050740 exp 10/20/2021). A risk assessment was done with Administrator, prior to entering the facility. There were 3 staff providing care and supervision for 6 residents.

Upon entry, LPA was checked-iin using a sign in sheet. LPA observed that as visitors arrived, staff screened and checked their temperature. There were indoor and outdoor visiting areas for residents. LPAs/Administrator conducted a tour through the facility and observed that the facility was clean and a comfortable temperature and passageways were free from obstructions. All auditory alarms were active. Signs were posted throughout the facility to promote hand washing and social distancing. Resident rooms were furnished per regulation. Extra hygiene products and cleaning products were available. Facility is able to designate a single isolation rooms for any asymptomatic or symptomatic residents in the event of an outbreak. Residents temperatures are checked daily and logged in facility phone. Facility has PPE supplies stored in hallway closet. Facility has conducted staff training on infection control.

LPA Walters is requesting that the Administrator submits and updated copy of the following documents by 7/2/2021: Copy of liability insurance, and Personnel Report (LIC 500). Facility has submitted a mitigation program plan that was approved on 5/10/21.

No deficiencies were cited during today's inspection.

SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Katrina Walters
LICENSING EVALUATOR SIGNATURE: DATE: 06/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/25/2021
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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