Facility Evaluation Report

Licensing Program Analyst (LPA) Katrina Walters conducted an announced pre-licensing inspection on 07/28/2022. LPA met with Applicant, Leah Martinez-Davis 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 Davis Senior Living, 486803816. Once the change of ownership is approved, the facility will be licensed as Arveah's Care Home 3. The facility has a fire clearance approval from the Vacaville 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; LPA was screened upon arrival.

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

All exits were unobstructed; 1 Fire Extinguisher charged and serviced 03/24/2022

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 (Personal Rights, Emergency plan/numbers, CCLD complaint poster, Ombudsman poster).

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

Medication was pre-filled for 3 days, in a 7 day pill container.

LPA learned that staff (S1) was not associated to Davis Senior Living.