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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803868
Report Date: 10/29/2021
Date Signed: 10/29/2021 02:50:35 PM

Document Has Been Signed on 10/29/2021 02:50 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:CAREWELL AT LAWLER RANCH, LLCFACILITY NUMBER:
486803868
ADMINISTRATOR:COLEMAN, ROBERTFACILITY TYPE:
740
ADDRESS:237 LAWLER RANCH PARKWAYTELEPHONE:
(707) 592-4004
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY: 6CENSUS: 4DATE:
10/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Ron Adriano, AdministratorTIME COMPLETED:
02:55 PM
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Licensing Program Analyst (LPA) Jill Nakagawa conducted 1 year required inspection and met with Administrator Ron Adriano. The inspection is focused on the Infection Control procedures and practices of this facility.

All visitors, essential visitors, and staff are screened upon entry; Temperatures are taken, and information is logged. Residents are screened and observed for any changes daily; all information is logged. Facility was a comfortable temperature with all exits free from obstruction. Toxins are stored in locked cabinets in laundry room. There was a sufficient supply of hygiene products, cleaners, and paper products for use as needed. Medications were stored locked making them inaccessible to residents and staff that do not handle medications. All exit alarms were on exit doors and working properly. All bathrooms had grab bars, and non-slip mat/flooring for bathing as needed. All postings were up and visible to all as required. Facility has a sufficient supply of personal protective equipment (PPE). Administrator and two (2) carestaff wore masks during the LPA's inspection. Facility has an approved hospice waiver for two (2) residents. Mitigation plan was approved by the Department on 05/06/2021. Fire clearance is approved for six (6) non-ambulatory.
There were four (4) residents in care at the facility during this inspection.

No deficiencies during today's inspection.
No citations issued.
Exit interview conducted with the Administrator.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2021
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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