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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803704
Report Date: 03/30/2023
Date Signed: 03/30/2023 01:35:58 PM


Document Has Been Signed on 03/30/2023 01:35 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:VISTA PRADO INCFACILITY NUMBER:
486803704
ADMINISTRATOR:WELDAY, ADIAMFACILITY TYPE:
740
ADDRESS:105 POWER DRIVETELEPHONE:
(707) 643-7617
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY:68CENSUS: 30DATE:
03/30/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
12:03 PM
MET WITH:Veronica DeLeon Tan, Assistant Direction TIME COMPLETED:
01:50 PM
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On 3/30/2022 Licensing Program Analyst (LPA), Tobola conducted a Case Management for the purpose of a Quarterly Non-Compliance visit and was greeted by Assistant Living Director, Veronica DeLeon Tan. LPA had temperature recorded and continued with the visit.

LPA was informed that the facility is undergoing management and operation changes and currently in the process for a change of ownership. Executive Director, Linda Cho and Assistant Director, Veronica DeLeon Tan will be serving as Administrators during the transition. Both of which have current Administrator Certification on file. Facility will be providing updates on the application process. In addition, LPA requested for required documentation for change of administrator.

LPA conducted a staff sample review of facility staff training conducted on Relias system. LPA reviewed newly hired and long-term staff records. Upon review LPA found that new staff are completing initial on-board training in a timely manner. In addition, annual reoccurring training for long-term staff is being completed appropriately.

In previous visits the facility was in the process of transitioning to the use of the ALIS database. However, training was not implemented by previous management company. Facility will continue to utilize Quick MAR and facility developed ADL Log for recording completed medication administration and daily living care. Upon review of records LPA found that multiple PM shift dates on the sample review of residents had not been properly completed or signed off. Licensee agrees to conduct an internal review of records and determine which staff had not properly completed the ADL logs. The records will be reconciled and in-service training will be provided to staff ensuring compliance. In addition, Licensee to submit written statement on facility plan to more appropriately and consistently audit ADL logs for residents. Technical Violation issued for corrections.

No deficiencies cited during today's visit.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Dominic TobolaTELEPHONE: (707) 588-5081
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2023
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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