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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390317903
Report Date: 08/18/2022
Date Signed: 08/18/2022 03:57:16 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/18/2022 03:57 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:CONTI ESTATE IIFACILITY NUMBER:
390317903
ADMINISTRATOR:CONTI, FRANCINEFACILITY TYPE:
735
ADDRESS:800 QUAKER RIDGE COURTTELEPHONE:
(209) 983-9186
CITY:LATHROPSTATE: CAZIP CODE:
95330
CAPACITY: 6CENSUS: 5DATE:
08/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Francine ContiTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Arielle Pascua arrived at the facility on 08/10/2022 at 1:15pm to conduct an unannounced annual visit. Upon arrival LPA Pascua rang the door bell and there was no answer at the door. LPA Pascua called the facility number on file and no one answered the phone. LPA Pascua left a voicemail with a return number. LPA Pascua will return at another time to complete the annual visit.

Licensing Program Analyst (LPA) Arielle Pascua arrived at the facility on 08/15/2022 at 9:30am to conduct an unannounced annual visit. Upon arrival LPA Pascua rang the door bell and there was no answer. LPA Pascua called the facility number on file and no one answered the phone. LPA Pascua left a voicemail with a return number. LPA Pascua will return at another time to complete the annual visit.

Licensing Program Analyst (LPA) Arielle Pascua conducted an unannounced Required 1-year inspection visit on 08/18/2022 at 11:45am. LPA Pascua met with Facility Designated Administrator, Francine Conti and stated the purpose of today's visit. There was one other staff member present, Angela Conti. Adminstrator holds a current certificate and expires on, 12/23/2022. The facility has a main entrance COVID screening point. The facility has a 30 day supply of PPE. The facility conducts disinfecting cleaning daily.
This facility is also vendorized to accept and retain Level 2 residents at this time. Census was currently at 5. Tour of the facility was conducted.
A tour of the facility was conducted. 3 Fire extinguishers located in the garage, main kitchen, and by the medication closet was annually inspected on 08/18/2022.
Dining areas, living areas, and all other areas intended for resident use were toured. It was observed that furniture and furnishings were sufficient and able to meet the needs of the residents at this time.
Kitchen area was toured. Food storage units were reviewed for adequate 2-day perishable and 7-day non perishable quantities at this time. Additional food supply was identified in the garage.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2022
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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: CONTI ESTATE II
FACILITY NUMBER: 390317903
VISIT DATE: 08/18/2022
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LPA Pascua observed a locked centralized stored medication cabinet located by the stairs. Along with Administrator, the LPA observed, reviewed, and compared resident medication with the medication dispensing logs. First Aid Kit was present and contained all of the required components.
A tour of the garage was conducted. Additional storage for supplies were identified. Washer and dryer were also identified. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time.
A tour of the 3 resident bedrooms was conducted. Resident furniture was observed to be sufficient to meet the resident needs at this time. A tour of the staff bedroom was also conducted.
A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees.
The exterior of the physical plant was in good repair with no hazards present. Perimeter fence was observed to be stable and gates were in good repair.

The following forms and documents were requested to be updated and submitted into CCL.
-LIC 308
-LIC 400
-LIC 500
-LIC 610

No deficiencies were observed or cited during this annual visit. A copy of this report was given to Facility Designated Administrator.
Exit interview.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022
LIC809 (FAS) - (06/04)
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