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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803874
Report Date: 11/22/2022
Date Signed: 11/22/2022 01:39:01 PM

Document Has Been Signed on 11/22/2022 01:39 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:TELECARE ENGLISH HILLSFACILITY NUMBER:
486803874
ADMINISTRATOR:OLIVES, ADAM J.FACILITY TYPE:
738
ADDRESS:7821 ENGLISH HILLS ROADTELEPHONE:
(707) 815-2511
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 4CENSUS: 4DATE:
11/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Administrator, Adam OlivesTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Telecare English Hills for the purpose of conducting a Required 1 year inspection. LPA was greeted at the door by Administrator, Adam Olives, and was granted access into the facility.

LPA toured the building and grounds with the Administrator and observed the facility to be clean and a comfortable temperature. LPA observed a supply of perishable and non-perishable foods as required by Title 22 regulations. Food was found to be stored in a safe manner. Water temperature measured at 115 degrees F in both clients bathrooms, which is within regulation between 105 and 120 degrees F in faucets used by clients. There was an ample supply of linens, cleaners, hygiene products and paper products available for clients. Toxins are locked in the laundry room and the locked storage outside. Toxins are inaccessible to clients in care. All clients bathrooms contained necessary grab bars and non-slip floors/mats. Medication is centrally stored in a locked closet closest to the facility kitchen. All bedrooms are equipped with lighting, appropriate furnishings and proper bedding which was clean and in good repair. Fire Extinguishers were last inspected August 2022. Smoke detectors and Carbon Monoxide Detectors were located throughout the facility. Both were tested and operational during the inspection. First Aid Kit was found to be appropriate during the inspection. Last emergency drill was conducted on November 12, 2022 and November 14, 2022.

LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Facility has PPE supply stored in the garage. Facility is N95 Fit tested in December 2021.

(Report continued on LIC 809C)
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: TELECARE ENGLISH HILLS
FACILITY NUMBER: 486803874
VISIT DATE: 11/22/2022
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LPA requested the following documents to be sent:

LIC 500- Personnel Report
LIC 308- Designation of Responsibility
LIC 309- Administrative Organization
LIC 400- Affidavit regarding Client Cash Resources
Updated facility sketch
Updated Emergency Disaster Plan (LIC 610D)
Surety Bond
Most up-to-date Liability insurance
Control of Property
Register of residents

No deficiencies were observed or cited during today's Required 1 year inspection. Exit interview was conducted and a copy of this report was emailed to the facility Administrator due to printer issues.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022
LIC809 (FAS) - (06/04)
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