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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803362
Report Date: 06/17/2021
Date Signed: 06/17/2021 12:00:52 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:VALLEY VIEW CARE HOMEFACILITY NUMBER:
496803362
ADMINISTRATOR:CREDO, JOSEPHINEFACILITY TYPE:
740
ADDRESS:515 MIDDLE RINCON ROADTELEPHONE:
(707) 538-2140
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY:6CENSUS: 5DATE:
06/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Administrator, Josephine CredoTIME COMPLETED:
12:10 PM
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Licensing Program Analysts (LPA) Victoria Willis and Erik Gonzalez Campos arrived unannounced, to conduct an annual required inspection and were greeted by staff. Administrator, Josephine Credo arrived later. The inspection is focused on the Infection Control procedures and practices of this facility.

Upon arrival, LPAs were screened by staff and screening was documented. LPAs initiated walk-through of the facility with administrator at 11:00 and observed COVID-19 posters throughout that included hand washing signs. Facility was a comfortable temperature and exits were free from obstructions. Infection control has been discussed with residents and staff. Hand sanitizer is located centrally for client and staff use. Observed staff had masks on during this visit. Commonly touched surfaces are disinfected on each shift.

Facility had a recent fire inspection on April 27, 2021. No smoke alarm issues were noted.

Common areas are set up for social distancing. Facility has a designated visitation area. Staff have completed PPE training and have been N95 fit tested.

Facility has submitted and received approval for their Covid Mitigation Plan. Facility has more than a 30 day supply of Personal Protective Equipment (PPE) including but not limited to masks, face shields, gowns and hand sanitizer. Facility maintains a 30 day supply of medication.

Facility has over 70 percent vaccination rate of staff and residents so may discontinue surveillance testing.

According to Administrator, they have reviewed PINs 21-17-ASC and 21-17.1-ASC for new guidance regarding visitation, communal dining, etc.



Administrator and LPAs discussed their Emergency Disaster Plan.

No deficiencies cited during this inspection.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Erik Gonzalez CamposTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021
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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