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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486801055
Report Date: 12/21/2021
Date Signed: 01/04/2022 12:34:44 PM

Document Has Been Signed on 01/04/2022 12:34 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:TWIN RESIDENTIAL CARE HOMEFACILITY NUMBER:
486801055
ADMINISTRATOR:ALMONIA, SONIA G.FACILITY TYPE:
735
ADDRESS:129 COLERIDGE DR.TELEPHONE:
(707) 644-1961
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY: 6CENSUS: 6DATE:
12/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:03 PM
MET WITH:Sonia AlmoniaTIME COMPLETED:
03:34 PM
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Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct an annual Required-1 year inspection and met with Sonia Almonia, Administrator. The annual inspection is focused on the Infection Control procedures and practices of this Adult Residential Facility. There is currently 6 clients in care.

LPA toured facility and grounds with administrator and observed COVID-19 precaution signs posted in common areas to promote hand washing and physical distancing. LPA was screened for COVID-19 symptoms upon entrance to this facility. Visitors are said to be screened for COVID-19 symptoms upon arrival to the facility. Infection control practices are present: entry procedures, face coverings, daily monitoring and temperatures checked for clients and staff, and 30-day PPE supply. Facility to follow indoor visitation requirement of verifying and tracking COVID-19 vaccination or verify non-essential visitors have proof of a negative COVID-19 test within 72 hours. Facility states staff clean and disinfect the facility daily. Facility understands hand sanitizer should not be placed in the rooms of residents who lack hazard awareness and impulse control. Bathrooms are equipped with liquid soap and paper towels. Covid-19 Mitigation plan was submitted to the department on 3/2/2021. Caregivers have completed PPE training but have not been N-95 Fit tested.
In addition, facility was found to be clean, at a comfortable temperature with all exits free from obstruction. Fire Extinguishers were found to be last charged and serviced on April 29, 2021.

LPA requested facility staff to get N95 fit tested.

Exit interview conducted with Sonia Almonia, and a copy of this report will be emailed to facility due to printer problems.
No deficiencies cited during today's inspection
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Araceli Canela
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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