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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803540
Report Date: 07/11/2024
Date Signed: 07/11/2024 11:59:18 AM

Document Has Been Signed on 07/11/2024 11:59 AM - 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/
DIRECTOR:
AMANDA SIMMONSFACILITY TYPE:
735
ADDRESS:707 MORNING SUN CTTELEPHONE:
(707) 449-3935
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 4CENSUS: 4DATE:
07/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:02 AM
MET WITH:Amanda Simmons, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On 7/11/2024, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. Inspection for this facility and was greeted by Administrator, Amanda Simmons. The facility currently provides care for 4 clients, some of which were at program or preparing for outings. LPA continued with a tour of the facility with staff. Client’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers were found to be last charged on 3/4/2024. Smoke and carbon monoxide detectors were interconnected tested and found to be in order. LPA had arrived during staff routine grocery outing, but Administrator ensures a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were stored properly as per regulations on this day at the time of the visit. There is a sufficient supply of linens, hygiene product and paper products available for client use. Items that could pose health & safety risk if accessible were found to be secured. LPA observed 3 total window screens in need of repair or replacement. Administrator indicated that an order for maintenance has been put into place and expected to be completed within 2 weeks. Photo corrections will be submitted to CCLD. Medications are located in the kitchen and found to be secured. A spot medication count was conducted for clients, medications and Centrally Stored Medication Records found to be in order. LPA conducted a review for staff files and found all staff to have appropriate training completed. LPA conducted a spot check of client records and found all clients to have updated physician's reports. P&I funds were reviewed and found to be in order and not commingled. Client's Individual Program Plans had been completed within the week. Administrator is awaiting completed report from North Bay Regional Center and will provide to CCLD once received.

Administrator, Amanda Simmon's Administrator Certification 6069014735 is valid through 5/15/2026.
LPA requested the following documents be sent to CCL by COB 7/25/2024:
LIC 610 Emergency Disaster Plan
LIC 9020 Register of Facility Client’s/Resident’s

No deficiencies cited.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2024
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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