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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803874
Report Date: 02/06/2024
Date Signed: 02/06/2024 11:35:39 AM

Document Has Been Signed on 02/06/2024 11:35 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: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: 3DATE:
02/06/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Hedi Noriesta, LVN ManagerTIME COMPLETED:
11:45 AM
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On 2/6/2024, Licensing Program Analyst, Tobola arrived unannounced for the purpose of conducting a case management to follow up on a facility self-reported incident and was greeted by LVN Manager, Heidi Noriesta. The facility utilizes a float pool staffing system where multiple staff are assigned to work at multiple homes under the Telecare Corporation. An incident occurred at the facility on 1/17/2023, where float pool staff (S1) had spoken in an inappropriate and demeaning way towards client (C1). During the incident, S1 was directed by management to discuss the actions that took place and was held in the facility office. The conversation was not held in any common spaces where clients typically reside, however C1 had walked into the office area and became aware of the conversation. The facility immediately ensured C1 was provided support and returned to baseline. The facility also directed staff S1 to end their shift and was appropriately reported to involved parties including, Department of Social Services and Adult Protective Services. LPA found the facility to have responded appropriately and provided adequate services for client during the incident.

LPA was informed that S1 was reported to the company and APS followed by contact and visit from the local Ombudsman and discussed the facility action no longer allowing staff S1 to work at the facility. LPA spoke with Regional Float Pool Manager, Leo Castaneda and discussed corrective actions and company plans moving forward. Corrections were discussed and Technical Violation issued.

No deficiencies cited.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2024
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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