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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486802066
Report Date: 07/15/2021
Date Signed: 07/15/2021 02:02:51 PM

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:CLARIN'S RESIDENTIAL CARE HOMEFACILITY NUMBER:
486802066
ADMINISTRATOR:CLARIN, JULIANAFACILITY TYPE:
740
ADDRESS:3024 CLEAR COAST COURTTELEPHONE:
(707) 557-6837
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:6CENSUS: 4DATE:
07/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator, Juliana ClarinTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA), Farhaan Sarangi arrived at Clarin's Residential Care Home for the purpose of performing a Required 1-year inspection. LPA was greeted at the door by Administrator, Juliana Clarin and was granted access into the home.

LPA Sarangi initiated a tour of the facility at 01:13 PM and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in resident's bathrooms measured at 111.6 and 111.2 degrees F which are within allowable range of 105 to 120 degrees F. Hygiene products and linens were available. Bathrooms had required bath mats and grab bars. Cabinet located in the laundry room in the hallway containing cleaning supplies were locked and inaccessible to residents in care. Medications are stored in a locked closet in the hallway. Knives are stored in a locked drawer in the kitchen. Facility has at least two days of perishable and one week of non-perishable foods. Required postings were observed. Fire extinguisher was last inspected July 2020. Smoke detectors located throughout the facility were tested and operational. Carbon monoxide detector was tested and operational. Exit doors have auditory alert system that were functional at time of visit. Last Emergency Disaster Drill was conducted on July 2020

LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. LPA observed staff not wearing masks and had masks improperly being worn.

No deficiencies were cited during today's Required 1- Year inspection. Exit interview was conducted and a copy of this report was signed and given to the Administrator, Juliana Clarin.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5029
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: 707-588-5034
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
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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