<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803874
Report Date: 09/21/2024
Date Signed: 09/21/2024 03:38:00 PM

Document Has Been Signed on 09/21/2024 03:38 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:
09/21/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:50 PM
MET WITH:Hailey Evansmajan, Lead RBTTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LIcensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an inspection of the facility re: maintenance and upkeep of the facility's common areas and resident rooms. LPA met with Lead RBT (Registered Behavior Technician) Hailey Evansmajan.

LPA and staff toured the facility and found it to be clean and odor free. The living room had recently been refurnished with a large sectional couch with washable covers and replaceable stuffing for ease of cleaning and maintaining a hygienic environment. The other furnishings in the common area had surfaces which could be wiped down and sanitized easily. Resident rooms were appointed per resident needs, and found to be clean and well-kept. Staff support residents with ADL's (activities of daily living).

No deficiencies found at the time of inspection.
No citations issued.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1