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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486801892
Report Date: 10/08/2021
Date Signed: 10/12/2021 09:58:12 AM

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:BENICIA LOVING CARE HOMEFACILITY NUMBER:
486801892
ADMINISTRATOR:GULAPA, LUCITAFACILITY TYPE:
740
ADDRESS:948 ROSE DRIVETELEPHONE:
(707) 748-1688
CITY:BENICIASTATE: CAZIP CODE:
94510
CAPACITY:6CENSUS: 6DATE:
10/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:Maria Datario and Bernadette FabricanteTIME COMPLETED:
02:02 PM
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Licensing Program Analyst (LPA) A. Canela arrived at this facility unannounced, to conduct an Annual Required infection control inspection. Benicia Loving CareThis inspection will focus on the Infection Control procedures and practices of this facility. LPA met with lead care giver Maria Datario and Bernadette Fabricante. There were 6 residents present at the facility.

LPA arrived at the facility and had temperature checked and health questions asked. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers were found to be charged and inspected within the last 12 months. Toxins are stored and not accessible. There was a supply of hygiene products and paper products available for resident use. Facility has a large supply of extra linens. LPA consulted regarding having a gate at the bottom of the stairs to prevent residents from going to the second level of the home.

Facility has submitted and received approval for a Covid Mitigation plan. Posters are in place at the entrance and throughout the building. The entrance area has a small table with hand sanitizer, thermometer and other items designated for visitors and staff before coming into work or visit. Facility has plenty of PPE supplies. Medications are secure and not accessible to residents. Facility has a 30-day supply of medication. Residents do not typically wear masks inside the facility but have them available. Residents do however, wear masks while away from the facility. All staff had masks on during this visit and screen LPA upon entrance.


There were no deficiencies found in the areas inspected.
No citations issued.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Araceli CanelaTELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
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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