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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804161
Report Date: 09/29/2023
Date Signed: 09/29/2023 04:02:41 PM

Document Has Been Signed on 09/29/2023 04:02 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:VISTA PRADOFACILITY NUMBER:
486804161
ADMINISTRATOR:CHO, LINDAFACILITY TYPE:
740
ADDRESS:105 POWER DRIVETELEPHONE:
(707) 643-7617
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY: 68CENSUS: 30DATE:
09/29/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:43 PM
MET WITH:Linda Cho, Licensee ApplicantTIME COMPLETED:
04:15 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
On 9/29/2023 Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of conducting a pre-licensing inspection and was greeted by Licensee Applicant, Linda Cho and Administrator, Veronica De-Leon Tan. This pre-licensing inspection is being conducted due to a change of ownership. Fire Clearance has been approved for a capacity of 68 residents; all of which may be non-ambulatory and none of which are bedridden. The facility was also granted a hospice waiver capacity of 20. There are currently 30 residents in care some of which with a diagnosis of dementia and 7 of which are on hospice. Licensee Applicant is in the process of transferring or re-admitting residents to the new facility ownership and will be completed upon issue of license.

LPA conducted a tour and inspection of the indoor and outdoor portions of the facility. Facility was found to be clean and comfortable temperature with all doors and exits free from obstruction. Fire extinguishers found throughout the facility were last serviced on 9/5/2023. Smoke detectors and carbon monoxide detectors in resident bedrooms and throughout the facility were interconnected, tested and found to be operating. Emergency exits along the both sides of the facility and front entrance have appropriate auditory alarm systems and found to be functioning. Water at faucets accessible to residents was measured in several bedrooms throughout the facility. Water was measured between 109.9 & 117.1 degrees F in faucets used by residents which falls within Title 22 Regulation between 105 & 120 degrees F.

There was an ample supply of fresh linens, continence care and hygiene products available with staff providing assistance on usage. A tour of the kitchen and food supply was inspected and found to be clean and orderly. Food supply is delivered once per week and food items were properly labeled. Information regarding resident dietary orders was observed on the kitchen bulletin with additional monthly menus. Residents are provided various nutritious meals with alternate options and snacks readily available upon request with a sufficient amount of food for the number of residents in care.
Continued onto LIC809-C
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2023
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 2
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: VISTA PRADO
FACILITY NUMBER: 486804161
VISIT DATE: 09/29/2023
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
26
27
28
29
30
31
32
Cleaning supplies, laundry products and other toxins were properly secured in designated storage closets and laundry room, along with housekeeping staff observed cleaning resident bedrooms during inspection. Medications are centrally stored in secured medication room with additional locked medication carts and refrigerators. A spot medication review was conducted and Centrally Stored Medication Records were found to be in order. The facility also conducts monthly medication audits and reconciles all records through an electronic database.

The Emergency Disaster Plan has been updated with appropriate evacuation sites, emergency procedures and templates for continuous emergency disaster drills all on file. Single facility van was inspected and found to be equipped with charged fire extinguisher and first aid kit. LPA was informed that the vehicle insurance and registration have been updated and Licensee Applicant is to provide copies of documentation.

Licensee will also be sending a copy of the updated liability insurance to CCLD once completed. Component III orientation was conducted with the Licensee Applicant. The pre-licensing evaluation has been completed. License will be granted upon completion of a final review and approval from the Licensing Program Manager. This report was reviewed with applicant and a copy was provided.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2