Facility Evaluation Report

Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Vista Home for the purpose of conducting a Case Management-Licensee Initiated inspection. LPA was greeted at the door by Caregiver, Liza Daahlen, and was granted access into the facility. Based on the STD 850, facility was approved for 3 Non-Ambulatory residents and 1 bedridden resident on February 22, 2023 and approved by the Fairfield Fire Department. LPA reviewed the STD 850 and the facility sketch and confirmed bedroom #3 was the room that was approved for a bedridden resident.

LPA and Caregiver toured the facility. Facility is a one story residence with four single resident bedrooms, two bathrooms and common areas. All resident rooms including bedroom #3 are appropriately furnished per regulation with a bed, lamp, dresser, chair and bedside table. Facility is clean and at a comfortable temperature with all exits free from obstruction.

No deficiencies were observed or cited during the Case Management-Licensee Initiated inspection. Exit interview was conducted and a copy of this report was given to the Caregiver.