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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803847
Report Date: 09/23/2022
Date Signed: 09/23/2022 12:23:08 PM

Document Has Been Signed on 09/23/2022 12:23 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:L & S GENTLE CAREFACILITY NUMBER:
486803847
ADMINISTRATOR:PADAMA, SAMUELFACILITY TYPE:
740
ADDRESS:162 N ALAMO DRIVETELEPHONE:
(707) 246-1100
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 6CENSUS: 5DATE:
09/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Samuel PadamaTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Katrina Walters arrived unannounced to conduct a Required 1-Year Inspection and was greeted by staff. The Licensees, Imelda and Samuel Padama arrived later. LPA observed that SP's Administrator Certification was currently expired. Per SP they have submitted a request to have their Administrator Certificate updated, but have not yet received their updated certificate. LPA verified through the Administrator Certificate bureau that the certificate is pending. SP will post Administrator Certificate once received. The inspection is focused on the Infection Control procedures and practices of this facility.

At primary entrance LPA observed a temperature logs and visitor sign-in sheet. Hand sanitizer was available for visitors. LPA conducted a walk through of the facility with staff and observed COVID postings throughout. Mitigation plan and Infection Control Plan was submitted and available for review. Hand sanitizer is kept throughout the facility. Per the Administrator staff are registered to have Personal Protective Equipment (PPE) /infection control training with local public health. Administrator maintains a binder with current COVID-19 protocols and contingency plans. LPA observed an inventory of PPE. Inventory of PPE is stored in garage and resident's bedrooms. LPA confirmed facility has at least a 30-day supply of PPE and incontinence products. High touch surface areas are disinfected daily. Due to current facility census, residents could isolate in their own bedrooms if they became ill.

Facility was a comfortable temperature and exits were free from obstructions. The fire extinguisher was last inspected 03/15/2022. Auditory Alarms, Carbon Monoxide and Smoke detectors were tested and appeared to be in working order. Residents' emergency contact information has been updated and administrator confirmed staff are familiar with emergency procedures and protocols. All staff have conducted disaster drills and their annual disaster drills will be completed again in November. Sharps and toxins are secured and inaccessible to residents. Medications are centrally stored in a locked closer. All staff and residents are vaccinated and boosted.

No deficiencies cited during today's visit.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Katrina Walters
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2022
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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