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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803874
Report Date: 12/21/2021
Date Signed: 12/21/2021 01:14:35 PM

Document Has Been Signed on 12/21/2021 01:14 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:TELECARE ENGLISH HILLSFACILITY NUMBER:
486803874
ADMINISTRATOR:SPIECKER, TIFFANYFACILITY TYPE:
738
ADDRESS:7821 ENGLISH HILLS ROADTELEPHONE:
(707) 815-2511
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 4CENSUS: 4DATE:
12/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Tiffany Spiecker TIME COMPLETED:
01:30 PM
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Licensing Program Analysts (LPA) Victoria Willis and Caitlynn Felias arrived unannounced, to conduct an Annual Required inspection and met with Administrator, Tiffany Spiecker. The inspection is focused on the Infection Control procedures and practices of this facility.

Upon arrival, LPAs were screened by Administratorl. LPAs temperatures were taken and were asked standard Covid-19 symptom questions. LPAs conducted a walk-through of the facility and observed hand washing signs in restrooms. Facility is unable to keep most Covid-19 posters on the walls due to client behaviors. Hand sanitizer is located in general areas but not in client rooms due to possible ingestion. Administrator provided documentation showing that staff are screened at the beginning of their shift and clients are screened twice a day. Facility was a comfortable temperature and exits were free from obstructions. Per Administrator, they regularly discuss infection control with residents and staff. Residents are encouraged to wear masks when outside of their rooms and staff are required to wear them while in the facility. Observed staff had masks on during this visit. Commonly touched surfaces are disinfected at least twice per day, after use. LPAs confirmed that facility is following the staff vaccination guidance per PIN 21-44-ASC. Administrator is reviewing PINs for ongoing CCL guidance.

Facility has a designated visitation area outside and is allowing for inside visitation after vaccination verification or proof of a negative test within 72 hours, per PIN 21-40-ASC visitors are required to wear a mask while in the facility. Facility has submitted their Covid Mitigation Plan and it has been reviewed by CCL. Facility has at least a 30 day supply of Personal Protective Equipment (PPE) including but not limited to masks, face shields, gowns and hand sanitizer. PPE is located in multiple areas of the facility and is accessible to staff who need it. Facility maintains a 30 day supply of medication. Caregivers have completed PPE training and have been N-95 Fit tested.
Administrator and LPAs discussed their Emergency Disaster Plan. Fire extinguishers were last serviced December 2021. Hardwired fire alarm system and Carbon Monoxide detector were tested and operational.

No deficiencies cited during this inspection.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Willis
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2021
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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