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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803868
Report Date: 09/23/2022
Date Signed: 11/04/2022 10:25:24 AM

Document Has Been Signed on 11/04/2022 10:25 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: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: 5DATE:
09/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ron-Mark Adriano, House Manager
Robert Coleman, via phone		TIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an Annual inspection at approximately 10:00 AM, and met with House Manager Ron-Mark Adriano. LPA also contacted Licensee Bob Coleman upon arrival. The inspection is focused on the Infection Control procedures and practices of this facility.

Upon entry LPA was screened for COVID symptoms. At primary entrance LPA observed temperature logs and visitor sign-in sheet. LPA conducted walk through of the facility with licensee and observed COVID postings throughout. Mitigation Plan and Infection Control Plan have been submitted.

Facility was a comfortable temperature of 75F and exits were free from obstructions. Facility was clean and orderly. Resident rooms were furnished as required and had a homey atmosphere. Hand sanitizer is kept throughout the facility. High touch surface areas are disinfected daily. Plan is in place to isolate residents if they become ill. LPA confirmed licensee has necessary PPE equipment and supplies to support a resident in isolation.

Toxins are secured and inaccessible in lockedk cabinet in laundry room. A 30 day supply of medications are stored in a locked cabinet, making them inaccessible to residents. The facility has a sufficient supply of Personal Protective Equipment (PPE) and hygiene supplies located in storage area. Facility has 100 percent vaccination rate for staff/residents and has therefore discontinued surveillance testing per CCL guidelines.

Fire extinguisher was last serviced on March 18, 2022. Carbon Monoxide Detector was tested and operational. All exterior doors were alarmed and operational.

There were no deficiencies found at the time of inspection. No citations issued.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2022
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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