Facility Evaluation Report

Licensing Program Analyst (LPA) Cuadra conducted the Post Licensing inspection and met with lead staff Cassie Guerrero designated substitute on file. Licensee/Administrator was not able to come to the facility due to their residency is a distance away from the facility, which it was previously discussed with Licensee during pre-licensing visit conducted on 12/15/22. LPA have a discussion via phone with Licensee and was informed their intentions are to appoint an Administrator that will ensure to spend a reasonable amount of time in the facility, resident's care needs will be met in case of an emergency and Community Care Licensing inspections. Documents needed to appoint a new Administrator are as follow: (LIC 500) Personnel Report, LIC308 Designation of Facility Responsibility, LIC215 Applicant Information, LIC501 CCL/Personnel Record and detailed employment/education history. Facility has a Dementia Care Plan approved to care for residents with dementia care needs. No residents in hospice.

Facility is a single story residence and has 5 bedrooms for residents in care. The fire clearance for six non-ambulatory residents was granted 11/1/2022 by Sonoma County Fire Department. Fire extinguisher was last serviced 12/13/2022. The facility have not conducted a fire drill for the last quarter. LPA/Staff initiated a tour of the facility at 9:00 am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Smoke alarms and carbon monoxide detector were tested and operational at time of inspection. Auditory alarms were functional at time of inspection. Water temperature in bathroom used by residents measured 127.6 degrees F which is not within the range of 105 to 120 degrees F allowed per regulation. Required postings observed.