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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700795
Report Date: 03/10/2022
Date Signed: 03/10/2022 01:13:13 PM

Document Has Been Signed on 03/10/2022 01:13 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:EMF FLORES CARE HOME #2FACILITY NUMBER:
342700795
ADMINISTRATOR:FLORES, ELOISAFACILITY TYPE:
740
ADDRESS:8500 PALLADAY ROADTELEPHONE:
(916) 991-3494
CITY:ELVERTASTATE: CAZIP CODE:
95626
CAPACITY: 6CENSUS: 4DATE:
03/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:43 PM
MET WITH:Eloisa Flores, AdministratorTIME COMPLETED:
01:45 PM
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On March 10, 2022, at 1pm, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to conduct an 1 year required annual review. LPA met with Eloisa Flores, Administrator and informed her the reason for the visit.
Prior to visit, LPA completed the required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19, contacted licensee and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and worn a mask for Personal Protective Equipment (PPE). Additionally, LPA was screened by the front desk personnel upon arrival.

Eloisa and LPA completed the inspection tool questionnaire with no issues or advisories to report.

LPA observed the following:

Administrator certificate is valid, expiring 5/13/2023. First aid kit fully stocked and ready for emergency use. Fire extinguishers is charged. Common areas were clean and in good repair. Bedrooms had required furniture and lighting. Facility has required (2) day perishable supply of food and (7) supply of non-perishable food. Medication was properly stored and locked away.

As a result of this visit, no deficiencies were cited, per Title 22 Regulations..

Exit interview conducted and a copy of this report given to Eloisa Flores.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2022
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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