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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496802026
Report Date: 05/25/2021
Date Signed: 05/25/2021 06:14:34 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:VILLA CAPRIFACILITY NUMBER:
496802026
ADMINISTRATOR:LIMBERG, STEPHANIEFACILITY TYPE:
740
ADDRESS:1397 FOUNTAINGROVE PKWYTELEPHONE:
(707) 526-9090
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:80CENSUS: DATE:
05/25/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Stephanie Limberg-AdministratorTIME COMPLETED:
06:00 PM
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Licensing Program Analyst (LPA) Dina Alviso conducted an Annual Required inspection and met with Administrator Stephanie Limberg. The inspection is focused on the Infection Control procedures and practices of this facility.

Facility has a Covid Mitigation plan approved by the Department. Facility has an approved hospice care waiver for thirteen (13) residents. Dementia plan of operation is approved by the Department.

Facility has sanitizer available in the entry area, and this is where all staff and visitors are screened, screening questions are asked, and temperatures taken. Signs posted for washing hands in the restroom(s). Residents are screened daily, screening questions asked, observations of all residents, and temperatures taken. All screenings are logged. Facility was found to be clean, orderly, and at a comfortable temperature. LPA observed exits free from obstruction. Toxins are stored in locked cabinets. Sufficient supply of hygiene products, cleaners, and paper products for use as needed. Medications are stored/ locked making them inaccessible to residents in care. Fire clearance approval for eighty (80) non-ambulatory residents, which includes 4 bedridden. All postings were up and visible to all as required. Facility has a sufficient supply of personal protective equipment(PPE). Residents have masks available to them for their use if needed and/or wanted. Administrator stated that all staff wear masks in the facility, and also when providing care services to the residents in and out of the facility. Administrator had a mask on during the LPA's inspection.
No citations today.
Exit interview with Administrator Stephanie Limberg.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina AlvisoTELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2021
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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