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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803829
Report Date: 07/20/2021
Date Signed: 07/20/2021 11:11:18 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:LOCUST GUEST HOMEFACILITY NUMBER:
486803829
ADMINISTRATOR:GULAPA, LUCITAFACILITY TYPE:
740
ADDRESS:223 LOCUST DRTELEPHONE:
(707) 980-6366
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:6CENSUS: 5DATE:
07/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH: Administrator, Bernadette FabricanteTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA), Farhaan Sarangi arrived at Locus Guest Home unannounced for the purpose of a Required-1 year inspection. LPA met with Administrator, Bernadette Fabricante and was granted access into the facility.

LPA toured the home with the Administrator and found the home to be at a comfortable temperature and was clean and in excellent condition. Smoke detectors and carbon monoxide detectors were tested and operational. The fire extinguisher located in the laundry room was serviced June 2021. There are auditory alerts on exit doors which were tested and functional. Water temperature in the resident bathrooms were tested and found to be within appropriate range of 105-120 degrees. Bathrooms have required non-skid surfaces and grab bars. Cleaning products and knives are stored in a locked cabinet in the kitchen. There is adequate space and furniture on the patio for outdoor activities. LPA observed a fireplace without a screen. LPA educated the Administrator on the importance of having a screen to cover the fireplace.

There was a 7 day supply of non-perishable foods. There are adequate dishes, glasses and silverware. Laundry equipment was present. The first aid had the required supplies. There were emergency lighting supplies and batteries present. There is a locked cabinet that will store residents' medications. Resident and staff files are located and locked in the Credenza.

In addition, LPAs advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Disaster Drills conducted on June 2021. Facility has PPE supply stored in the storage office located on the side of the facility. Staff have had all PPE training required on file and still working towards acquiring N-95 fit testing.

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

DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
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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