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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803084
Report Date: 01/07/2025
Date Signed: 01/07/2025 04:24:59 PM

Document Has Been Signed on 01/07/2025 04:24 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:RIO VISTA CARE HOMEFACILITY NUMBER:
486803084
ADMINISTRATOR/
DIRECTOR:
LAQUINDANUM, MARIAFACILITY TYPE:
740
ADDRESS:185 TRINITY COURTTELEPHONE:
(707) 374-3777
CITY:RIO VISTASTATE: CAZIP CODE:
94571
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
01/07/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:07 AM
MET WITH:Maria LaQuindanum, LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived at the facility unannounced on 1/07/2025 to conduct an Annual Inspection. LPA met with licensee Maria Laquindanum, and explained the purpose of the visit. The facility currently has 6 residents and there were three staff on site at the time of inspection. Each resident was clean and dressed appropriately; 4 of the 6 residents socially engaged in the large family room, listening to music.

LPA and licensee toured the interior and exterior of the facility to ensure health and safety of residents in care. Areas toured include but are not limited to:. common areas, resident bedrooms, two bathrooms, kitchen and dining. The facility was a comfortable 72 degrees F. In the areas toured no immediate health, safety, or personal rights violations were observed. All exits were clear of obstructions. The kitchen was clean and well-maintained. There was an ample supply of non-perishable foods. LPA requested more perishables be available, although there were plenty of fresh fruits.

LPA reviewed three staff files and found one staff file missing documentation of dementia training. New regulations and the increase in training were discussed. Licensee to forward the documentation of staff training by 1/15/2024. Resident files were missing appraisal forms but information was in Needs and Services Plans. LPA reviewed documentation with Licensee and the regulations regarding dementia care. LIcensee to ensure all pre-appraisal information is included in resident files.

LPA requested the following documents be submitted by email to LPA by 1/8/2025: Administrator packet for new administrator, Keanu Guintu, LIC500, LIC308, Resident Roster

Areas discussed: Administrator paperwork, new Dementia definition, copy of the new PIN given to Licensee.

No citations issued at the time of inspection.

Kimberley MotaTELEPHONE: (707) 588-5051
Jill NakagawaTELEPHONE: 707-588-5063
DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
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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