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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
486830735
Report Date:
08/29/2023
Date Signed:
08/29/2023 02:23:44 PM
Document Has Been Signed on
08/29/2023 02:23 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:
VACA VALLEY LIVING A MEMORY CARE COMMUNITY
FACILITY NUMBER:
486830735
ADMINISTRATOR:
JAMIE HEALER
FACILITY TYPE:
740
ADDRESS:
80 ORANGE TREE CIRCLE
TELEPHONE:
(707) 724-6751
CITY:
VACAVILLE
STATE:
CA
ZIP CODE:
95687
CAPACITY:
60
CENSUS:
36
DATE:
08/29/2023
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
01:08 PM
MET WITH:
Jamie Healer, Administrator
TIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an inspection and look into an incident self-reported by the facility.
LPA met with Administrator Jamie Healer (JH) and staff member (S1) regarding the possible theft of medications by a staff member (S2).
S1 had been checking the inventory of medications and a discrepancy was found. S1 was able to verify that medications were missing. Video of the medication room identified an individual (S2) who appeared to be pocketing the medications. Police were notified and a report was filed. S2 was terminated. There have been no further incidents of missing medications.
There were no deficiencies found at the time of inspection.
No citations issued.
SUPERVISORS NAME
:
Kimberley Mota
LICENSING EVALUATOR NAME
:
Jill Nakagawa
LICENSING EVALUATOR SIGNATURE
:
DATE:
08/29/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/29/2023
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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