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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803027
Report Date: 03/29/2022
Date Signed: 03/29/2022 02:39:09 PM

Document Has Been Signed on 03/29/2022 02:39 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:ONE STEP AT A TIME CARE HOMEFACILITY NUMBER:
486803027
ADMINISTRATOR:VILLALOBOS-SANTOS, MARIAFACILITY TYPE:
735
ADDRESS:503 MARINA BLVDTELEPHONE:
(707) 427-8553
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY: 6CENSUS: 4DATE:
03/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Fabricio Santos, AdministratorTIME COMPLETED:
02:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Walters arrived unannounced to conduct a REQUIRED 1 Year Annual Inspection. LPA was greeted by Administrator, Fabricio Santos. This visit is focused on the infection control. The facility submitted an infection control mitigation plan to Community Care Licensing, which was approved on 09/30/21. At the time of inspection, there was one staff providing care and supervision three clients in care.

LPA began tour with Administrator at approximately 1:05 PM. The facility was clean and a comfortable temperature. There were no exits that were obstructed. Signs were posted throughout the facility to promote social distancing and hand washing. LPA observed a 30 day supply of medication and incontinence products.

LPA conducted a record review of staff and resident records. LPA learned through record review that all staff have been vaccinated, and have been trained on infection control and the use of Personal Protective Equipment. Per Administrator all staff have been fit tested for N-95 mask. Client's vaccine cards are stored in their individual files. The carbon monoxide and smoke detectors were tested and they appeared to be in working order. 2 of 2 Fire extinguisher was last serviced on 06/17/2020.

LPA and Administrator discussed:
  • Having fire extinguisher inspected yearly
  • Creating a sign in area with a screening list and temperature gun.
  • Maintaining a 30 day supply of PPE


Appeal Rights Provided.
Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiencies and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Licensee Eileen Saddi whose signature below confirms receipt of this report.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Katrina Walters
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2022
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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Document Has Been Signed on 03/29/2022 02:39 PM - It Cannot Be Edited


Created By: Katrina Walters On 03/29/2022 at 02:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: ONE STEP AT A TIME CARE HOME
FACILITY NUMBER: 486803027

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87203
87203 Fire Safety - All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 2 out of 2 fire extinguisher was charged but not serviced which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/01/2022
Plan of Correction
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Licensee to have 2 of 2 fire extinguishers serviced. Licensee to submit Proof of Correction (POC) that fire extinguishers have been serviced and charged by a fire extinguisher service company or the Fire Department. POC due date 04/01/2022
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Hope DeBenedetti
LICENSING EVALUATOR NAME:Katrina Walters
LICENSING EVALUATOR SIGNATURE:
DATE: 03/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/29/2022


LIC809 (FAS) - (06/04)
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