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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
576804125
Report Date:
01/26/2024
Date Signed:
01/26/2024 04:09:17 PM
COMPREHENSIVE INSPECTION
Document Has Been Signed on
01/26/2024 04:09 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:
LA CASITA SENIOR CARE
FACILITY NUMBER:
576804125
ADMINISTRATOR:
HERNANDEZ, JESSICA
FACILITY TYPE:
740
ADDRESS:
900 DUNCAN CIR
TELEPHONE:
(530) 665-6277
CITY:
WOODLAND
STATE:
CA
ZIP CODE:
95776
CAPACITY:
6
CENSUS:
3
DATE:
01/26/2024
TYPE OF VISIT:
Case Management - Annual Continuation
UNANNOUNCED
TIME BEGAN:
03:00 PM
MET WITH:
Jessica Hernandez, Administrator
TIME COMPLETED:
04:08 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an Annual-Continuation Inspection at La Casita Senior Care. At the time of inspection there were 3 residents and 2 staff.
Administrator Jessica Hernandez accompanied LPA on a tour of facility. LPA found facility clean and well-organized. Bathrooms had required grab bars and showers had either a non-skid surface or bath matsas well as shower chairs. Kitchen was clean and sharps were locked and inaccessible to residents. Toxins were locked in laundry room and inaccessible to residents.
Residents were all clean and dressed appropriately. Staff were busy interacting with residents as they all watched a Western movie together.
LPA continued a review of facility's resident and personnel files and found them to be complete and well-organized.
No deficiencies were found at the time of this inspection. No citations issued.
SUPERVISOR'S NAME:
Kimberley Mota
TELEPHONE:
(707) 588-5051
LICENSING EVALUATOR NAME:
Jill Nakagawa
TELEPHONE:
707-588-5063
LICENSING EVALUATOR SIGNATURE:
DATE:
01/26/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/26/2024
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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