Facility Evaluation Report

Licensing Program Analyst (LPA) Katrina Walters conducted an unannounced pre-licensing inspection on 12/23/2022. LPA met with Applicant, Lunigning Sikat, and Janolyn R. De Guzman (6063333740 exp 08/05/2024) who will be the Administrator once the facility is approved for licensure. The applicant submitted an application to change ownership to the centralized application unit. The facility is currently licensed as The Good Samaritan Care Home, 486800302 . Once the change of ownership is approved, the facility will be licensed as Good Samaritan Care Home, 48604114.

The facility has a fire clearance approval from the City of Suisun City Fire Department for a total capacity of 6 Non-Ambulatory residents (the facility does not have approval for bedridden). Facility will operate with 24/7 staffing (staff room available) and Licensee will ensure sufficient staffing at all times.

During today’s visit LPA observed the following items:

COVID-19 postings and screening station including thermometer and sign in sheet

Lockable separate cabinets for toxins/cleaners, and knives.

All exits were unobstructed; 1 Fire Extinguisher charged and serviced 10/04/2022

Smoke detectors and 1 carbon monoxide detector, which were tested and observed operational

Complete first aid kit, night-lights leading to bathroom, and flashlight for emergency lighting

Supply of linens, paper products, and hygiene supplies available

Required furnishings in all resident bedrooms

Required postings (Emergency plan/numbers, CCLD complaint poster, Ombudsman poster).

Medication was centrally stored behind a locked closet.