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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486801542
Report Date: 11/22/2022
Date Signed: 11/22/2022 11:45:47 AM

Document Has Been Signed on 11/22/2022 11:45 AM - 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:LEISURE HOMEFACILITY NUMBER:
486801542
ADMINISTRATOR:SLAY, BRENDAFACILITY TYPE:
735
ADDRESS:931 READING WAYTELEPHONE:
(707) 451-4905
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 4CENSUS: 2DATE:
11/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH:Brenda SlayTIME COMPLETED:
11:59 AM
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Licensing Program Analyst (LPA) Walters arrived at the Adult Residential Facility (ARF) unannounced to conduct Required- 1 Year visit and met Administrator/Licensee, Brenda Slay. This inspection will focus on the infection control procedures this facility.

This facility is a two-story home with 5 bedrooms: 2 bedroom are designated for client usage. There are currently 2 clients residing in this facility. In the event of an outbreak, the clients are able to maintain distancing in each room. The facility operates with 24 hour live-in staffing that provide care and supervision. During the inspection clients were listening to music. Clients have not yet return to day program, however the Administrator is working with North Bay Regional Center to reinstate clients back into day program.

At the entrance of the home, there is a table with sanitizer and a sign in sheet available for visitors. There is at least a 30 day supply of incontinence products and personal protective equipment. There are emergency lights in the hallway. All exits and walkways were found to be unobstructed and were free of debris. Fire extinguishers were charged, last serviced on 11/03/2022. Smoke and carbon monoxide detectors were tested and found to be operational.

The home was a comfortable temperature, clean and was observed to be in good repair. Per Administrator major surface areas are disinfected routinely. In the event that a client/staff are showing symptoms facility has procedures for testing for COVID -19. Bathrooms were stocked with hand washing supplies and paper products. Signs were posted in the bathroom to promote hand washing.
No deficiencies cited during visit.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Katrina Walters
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2022
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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