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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001696
Report Date: 02/02/2022
Date Signed: 02/02/2022 11:08:27 AM

Document Has Been Signed on 02/02/2022 11:08 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
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: 5DATE:
02/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Neal TorresTIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Cassie Yang arrived unannounced on 2/2/2022 at 10:15 am to conduct a required annual. LPA met with Manuel Ramos, Caregiver, and explained purpose of inspection. LPA completed required COVID-19 testing protocols and completed daily assessment and confirmed the facility does not currently have any positive COVID-19 diagnoses. LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask. Caregiver contacted Neal Torres, Administrator, who arrived shortly to the facility at 10:40 am. The facility has an approved mitigation plan.

LPA toured the interior of the facility together with Administrator to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, bathroom, kitchen and laundry room. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA informed Administrator to have trash bin with lid. LPA and Administrator completed the a review of infection control and facility was found to be in compliance at this time.

LPA and Administrator discussed vaccination status of residents and staff.

No deficiencies are being cited as a result of today's inspection.

Exit interview conducted and copy of report left at the facility..
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2022
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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