Facility Evaluation Report

Licensing Program Analyst (LPA) A. Canela conducted an unannounced pre-licensing inspection on 09/22/2021, for this change of ownership application. LPA met with applicant Yolanda DeGuzman, and Dante Guinto, who will be the Administrator for Heart and Haven Homecare. The facility received a fire clearance approval from the Vallejo Fire Department on 7/7/2021 for a total of 6 Non-ambulatory residents. Applicant will ensure sufficient staffing at all times. The facility is one level home with 6 bedrooms , of which 5 bedrooms may be used for residents, 2 bathrooms, living room, dining room, kitchen, medication room, and garage.

During today’s visit LPA observed the following items:

· COVID-19 postings and screening station at entrance

· Lockable separate cabinets for medications, toxin, and knives.

· 6 smoke and 1 carbon monoxide detectors, which were all operational.

· First Aid kit and flashlights for emergency lighting.

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

· Grab bars and non-slip mat in bathroom.

· Fire Extinguisher charged and serviced 06/8/2021

· The water temperature was tested during inspection and LPA observed reading of 105 which is within regulation of 105-120 Degrees F.

· LPA observed at least a minimum of a 2 day supply of perishable and 7 day supply of non-perishable food necessary for 5 clients.

The Component III Orientation was completed with Applicant along with file review of resident/staff file.

Report continued on LIC809-C for corrections needed prior to licensure