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Inspection visit

Routine inspection

PROVIDENCE HOME OF VALLEJOLicense 4868038502 citations on this visit
2 citations recorded

Inspector’s narrative

What the inspector wrote

At approximately 8:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Required-1 Year inspection. LPA met with Administrator Michelle Jangar and explained the purpose of the visit. Administrator certificate is current. Facility has a Hospice waiver for 6 residents. At approximately 9:00AM, LPA toured the facility to ensure the health and safety of residents in care. The facility was observed to be at a comfortable temperature. Areas toured include but are not limited to resident rooms, common areas, bathrooms, kitchen, storage areas and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. Fire extinguishers were fully charged. Smoke detectors are all operational. Carbon Monoxide Detector was present. The common areas, bathrooms and kitchen were clean and in good repair. All bedrooms had required furniture, bedding, and lighting. The kitchen contained cooking/dining equipment that was clean and orderly, utensils were present. Food appears to be stored and prepared properly. Refrigerators and freezers were maintained at the proper temperature. Facility has required seven-day non-perishable and two-day perishable supply of food. Emergency food stores and water was present to ensure facility can be self-sufficient for 72 hours. Emergency lighting devices were present. First aid kit was present. All employees requiring background checks are cleared. No pools/bodies of water are on the premises. Facility has not been conducting Emergency drills every 3 months. At approximately 10:00AM, LPA reviewed 5 of 6 resident files. All resident files contained the required documentation. Reappraisals were conducted within the last 12 months. Documentation of physician visits within the last 12 months. At approximately 11:15AM, LPA conducted a review of medications. Medication is locked and not accessible. Continued on LIC809-C... At approximately 12:20PM, LPA reviewed 4 of 4 staff files. Staff files reviewed did not contain evidence of completed annual training. First Aid/CPR certification was current. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: Evidence of control of Property, (Current Rental/Lease Agreement/Deed) LIC500- Personnel Report LIC610E- Disaster Plan Evidence of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Michelle Jangar and Appeal rights were given.

Citations

2 citations recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 1569.625(b)(2)Type B

    Based on record review, the licensee did not comply with the section cited above in 4 of 4 staff records. Records did not contain evidence of required annual training, which poses/posed a potential health, safety or personal rights risk to persons in care.

  • 1569.695(c)Type B

    Based on record review, the licensee did not comply with the section cited above. Records did not contain documentation of completed quarterly drills, which poses/posed a potential health, safety or personal rights risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the June 6, 2025 inspection of PROVIDENCE HOME OF VALLEJO?

This was an inspection of PROVIDENCE HOME OF VALLEJO on June 6, 2025. 2 citations were issued: 2 Type B.

Were any citations issued to PROVIDENCE HOME OF VALLEJO on June 6, 2025?

Yes, 2 citations were issued (0 Type A, 2 Type B). The first citation was for: "Based on record review, the licensee did not comply with the section cited above in 4 of 4 staff records. Records did no..."

What type of inspection was this?

This was an inspection. Inspections are conducted by CCLD as part of their licensing oversight.

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Data from CCLD public records. Last updated . If you believe any information is inaccurate, report it here.