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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803874
Report Date: 05/31/2024
Date Signed: 05/31/2024 12:04:03 PM

Document Has Been Signed on 05/31/2024 12:04 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/
DIRECTOR:		ABBY CARVAJALFACILITY TYPE:
738
ADDRESS:7821 ENGLISH HILLS ROADTELEPHONE:
(707) 815-2511
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 4CENSUS: 3DATE:
05/31/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Heidi Noriesta, LVN Manager Abby Carvajal, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On 5/31/2024, Licensing Program Analyst, Tobola arrived unannounced for the purpose of following up on previous case management regarding staff document review for facility internal investigation and was greeted by LVN Manager, Heidi Noriesta and Administrator, Abby Carvajal. LPA Tobola gathered staff (S1) documents for review and conducted interviews with lead staff. The facility is continuing internal investigation.

LPA was informed of the plans for two clients transitioning from the facility program along with two potential new clients to be admitted within the next following weeks. LPA and staff also discussed recent concerns with client (C2) and self-neglecting behaviors and refusal of assistance on personal hygiene. Facility will be following up with appropriate self-reporting requirements due to potential personal rights risks to other clients in care.

No deficiencies cited during today's visit.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2024
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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