Facility Evaluation Report

Carlson Home, Fairfield04/25/2025Licence 486804211

Capacity4
Census1
Date signed04/25/2025 12:15:54 PM
Name of licensing program analystAli Deniz
Name of licensing program managerVictoria Bertozzi
The inspector’s account

At approximately 09:40AM, Licensing Program Analyst (LPA) Ali Deniz conducted an unannounced Annual Required – 1 yr. inspection for this adult residential facility. LPA was greeted by staff, Patrick Fernandez and Paulyn Bitare. Administrator, Nina German was contacted and arrived later in the visit. The facility is licensed for 4 non-ambulatory residents. The facility currently provides care for 1 resident, none of which are receiving hospice services. Facility is a 1 story building with 4 Resident bedrooms, 2 bathrooms, and common spaces.

At approximately 10:15AM, LPA toured the building with administrator, Nina German and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. LPA observed activity supplies for resident use. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Cleaning supplies and other toxins are safely stored in a locked cabinet in the laundry room and garage all of which were secured upon inspection. Sharps and other kitchen supplies that could pose danger if available to residents were found secured in a kitchen drawer. Water was measured at faucets accessible to residents between 111.2 and 108.4 degrees F which is within regulation between 105 and 120 degrees F at faucets accessible to residents. Fire Extinguishers found throughout the facility to be recently charged on 02/07/2025 at the time of visit. Smoke and carbon monoxide detectors are interconnected throughout the facility, were tested and found to be functioning. There was enough lighting in all common areas, resident rooms, and hallways

Medications located in the hallway area and were found to be secured/locked. LPA conducted a spot check of medications and found all administering and records to be in order.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction