Facility Evaluation Report

Licensing Program Analyst (LPA) Karina Canela conducted a pre-licensing inspection on 1/18/2022.

LPA met with applicant Jennifer Landas who will be the Administrator once the facility is approved for licensure. Additionally Alfred Landas, Annabelle Lewis-Barreto and Ruben Poblete were present. The facility has a fire clearance approval from the Fairfield Fire Department of 1 ambulatory, 2 non-ambulatory, and 1 bedridden - for a total of 4 residents. Facility will operate with 24 hour staffing and Licensee will ensure sufficient staffing at all times.

During today’s visit LPA observed the following items:

· Lockable separate cabinets for medications, toxins/cleaners, and knives.

· 7 hardwired combination smoke and carbon monoxide detectors, which were tested and observed operational

· Complete first Aid kit, night-lights, and flashlights for emergency lighting

· Supply of linens, paper products, and hygiene supplies available

· Fire Extinguisher charged and serviced 04/14/2021

· Administrator Certifications; Required postings (Personal Rights, Emergency plan/numbers, CCLD complaint poster, and visitor policy).

· The water temperature was tested during inspection and was within regulation of 105-120 Degrees F.

The Component III Orientation was completed. Pre-licensing is incomplete with corrections needed.

** Non-slip mats are needed in 2 of 3 bathrooms. Applicant to send pictures to LPA as proof of correction. Once LPA receives pictures of correction, LPA will submit the pre-licensing application report to the Application Unit Analyst in Sacramento; Application Unit Analyst will notify applicant of application status. No deficiencies cited during this visit