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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803540
Report Date: 08/25/2023
Date Signed: 08/25/2023 04:33:21 PM

Document Has Been Signed on 08/25/2023 04:33 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:PEOPLE'S CARE MORNING SUNFACILITY NUMBER:
486803540
ADMINISTRATOR:ASHLEY JOHNSONFACILITY TYPE:
735
ADDRESS:707 MORNING SUN CTTELEPHONE:
(707) 449-3935
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 4CENSUS: 4DATE:
08/25/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Ashley Johnson, AdministratorTIME COMPLETED:
04:45 PM
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On 8/25/2023, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of an annual continuation visit and was greeted by Administrator, Ashley Johnson. Facility provides care for 4 clients all of which were on outings or attending day program at the time of visit. LPA conducted a sample file review of staff and found all staff to have updated 1st Aid & CPR training certification on file. In addition, LPA conducted a file review for all clients (C1, C2. C3 & C4) and found clients to have updated Physician's Reports and Needs & Service Plans or Individual Program Plans from North Bay Regional Center.

Upon a review of client files, C1 was found to have an updated 1:1 ratio care supervision plan. Facility staffing is currently sufficient to meet the level of care for all of the clients in care. Facility is currently partnered with an outside staffing agency and is provided one additional agency Direct Support Staff. LPA was informed that the facility has recently transitioned to the RELIAS system to conduct staff training. Upon review of training LPA found that staff have completed several hours within the RELIAS system however several training hours were not indicated on the staff transcripts. Administrator to contact RELIAS to reconcile training hours.

LPA conducted a spot medication check and found 1 out 1 client C2's medication not indicated on the Centrally Stored Medication form. However, upon review of C2's Medication Administration Records, the medication, prescription order and start date was indicated. Administrator agrees to conduct a medication audit and reconcile records. Technical Violation issued. Lastly, LPA conducted a review of client P&I and found monies to be in order and not commingled.

No deficiencies cited during today's visit.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2023
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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