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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920088
Report Date: 08/29/2024
Date Signed: 09/11/2024 11:25:49 AM

Document Has Been Signed on 09/11/2024 11:25 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:VISTA ESPERANZAFACILITY NUMBER:
345920088
ADMINISTRATOR/
DIRECTOR:		VALENCIA, BRANDYFACILITY TYPE:
740
ADDRESS:5240 JACKSON STREETTELEPHONE:
(415) 590-0579
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY: 54CENSUS: 0DATE:
08/29/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:07 AM
MET WITH:, Brandy Valencia, DirectorTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On August 29, 2024, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived announced to conduct a Pre-Licensing Inspection. LPA met with Brandy Valencia Senior Administrator, who assisted in today's inspection. The Administrator's Certificate expires 1/26/2026. The facilities capacity is 54. The facilities Administrator’s Certificate, Emergency Disaster Plan, Resident’s Rights and Facility Sketch were available for viewing. The room temperature was 69 degrees F which is within range.

This is a county funded specialized program that accommodates 54 dual diagnosed residents, and is set to open Mid-September 2024. The facility is a one-story building. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, entertainment lounge, group conference rooms, and the kitchen. In the kitchen area, cabinets and drawers were reviewed. Knives and sharp objects were reviewed to make sure that they were locked and made inaccessible to the residents at all times. Hot water temperature was taken in the kitchen and measured at 119 degrees F, which is within the allowed range of 105-120 degrees. There’s appropriate lighting throughout the facility.

To continue see 809-C...
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: VISTA ESPERANZA
FACILITY NUMBER: 345920088
VISIT DATE: 08/29/2024
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Bedrooms have all required items of furniture. Bathrooms are community used rooms and consisted of grab bars and non skid mats. All sinks, toilets and showers work properly. The facility has a sufficient supply of linens, towels, bedding, etc. for residents in care. Washer and dryer was present and operate properly. Toxic substances, laundry and cleaning supplies will be inaccessible.

Several unopened first aid kits were present. Fire alarms, smoke alarms, and carbon monoxide detectors operate properly. Fire extinguishers are maintained and ready for emergency use. The facility was observed to have been annually inspected by Fire Code in June 2024 and is in compliance at this time. There’s a centralized area for resident’s medication. Medication room is secured and locked at all times. Medications will be dispensed right outside of the Med-Room.

LPA inspected the exterior grounds of this facility. There are no bodies of water on the premises. There are 2 shaded areas in the backyard for lounging or eating. The perimeter fence, side gates, and latches are all in good repair. Passageways are free of obstruction and potential hazards.

LPA's reviewed Personnel Policies, Abuse Reporting Procedures, In-Service Training and Medication Procedures with the applicant. The Disaster Plan is posted along with emergency numbers, complaint filing procedures facility theft and loss policy, and resident’s personal rights.


LPA's conducted Component III-Operations and Records Keeping Orientation. This orientation consisted of review of compliance expectations, forms, facility visits, civil penalties, and inspection authority. Component III completed.

Licensure pending approval from Central Application Unit .

Per California Code of Regulations, Title 22 Division 6, Chapter 8, no deficiencies were observed today.

An exit interview was conducted and a copy of this report was given to Brandy.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
LIC809 (FAS) - (06/04)
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