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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001696
Report Date: 09/01/2021
Date Signed: 09/01/2021 04:56:40 PM

Document Has Been Signed on 09/01/2021 04:56 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:LA HONDA GUEST HOMEFACILITY NUMBER:
347001696
ADMINISTRATOR:TORRES, MARGARITAFACILITY TYPE:
740
ADDRESS:3940 LA HONDA WAYTELEPHONE:
(916) 944-8909
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 6CENSUS: 6DATE:
09/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Administrator, Neal TorresTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Llopis arrived at the facility unannounced on 09/01/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain, LPA met with administrator Neal Torres and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and completed a facility risk assessment upon entry.

LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 Mask. Additionally, LPA was screened by facility upon entry.

LPA and administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, brief inspection of six (6) resident bedrooms, resident bathrooms, kitchen area, dinning area, and outdoor patio. In the areas toured no immediate health, safety, or personal rights violations were observed.

LPA and administrator completed the infection control domain together and facility was found to be in compliance at this time.

No deficiencies are being cited as a result of todays inspection.
Exit interview conducted and copy of report provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melana Llopis
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2021
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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