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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803084
Report Date: 01/28/2022
Date Signed: 01/28/2022 05:06:14 PM

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:RIO VISTA CARE HOMEFACILITY NUMBER:
486803084
ADMINISTRATOR:LAQUINDANUM, MARIAFACILITY TYPE:
740
ADDRESS:185 TRINITY COURTTELEPHONE:
(707) 374-3777
CITY:RIO VISTASTATE: CAZIP CODE:
94571
CAPACITY:6CENSUS: 3DATE:
01/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:07 PM
MET WITH:Administrator, Maria LaquindanumTIME COMPLETED:
05:20 PM
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On 1/28/2022, Licensing Program Analyst (LPA) Walters arrived unannounced to conduct an Annual/Required 1 Year inspection and was greeted by Maria Laquindanum, Administrator.This inspection is focused on infection control. The facility has already submitted an infection control mitigation plan, which was approved by Community Care Licensing on 10/05/21.

At the entrance of the facility, hand sanitizer and disposable mask were available to visitors. LPA toured facility and grounds with administrator and observed COVID-19 precaution signs posted in common areas to promote hand washing and physical distancing. Staff were wearing mask throughout the entire visit. The facility was clean and comfortable temperature. Per Administrator, the facility is disinfected daily and after usage. Signs detailing on how to wash hands were posted in the bathroom. Bathrooms were also supplied with hand washing supplies and paper towels. Facility has an emergency supply of Personal Protective Equipment and incontinence products. Facility has a designated visiting area. In the event that a resident test positive, the facility is able to isolate and quarantine each resident in there room. Smoke detectors and carbon monoxide detectors appeared to be operational. The fire extinguisher was last inspected on 6/21/21.

Staff have not yet been fit tested for N95 mask, Administrator will schedule fit testing. Per Administrator they have scheduled droplet precautions and personal protective equipment training with Local Public Health. Administrator agreed to sending LPA a written copy of the staff training, that list the staff who attended. LPA advised that the facility uses trash cans with lids to prevent the spread of airborne viruses. Administrator will also develop screening questions for visitors, to ensure they're not exhibiting COVID symptoms and send a copy to LPA by 2/2/2022. No citations cited during today's visit.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Katrina WaltersTELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2022
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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