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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803868
Report Date: 10/24/2023
Date Signed: 10/24/2023 02:44:35 PM

Document Has Been Signed on 10/24/2023 02:44 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, 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: 4DATE:
10/24/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Ron-Mark Adriano, House ManagerTIME COMPLETED:
02:45 PM
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LIcensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to review the circumstances surrounding an incident reported to Community Care Licensing. At the time of LPA's arrival, there were 3 clients at the facility, and one in hospital. There were 2 staff. House Manager Ron-Mark Adriano arrived shortly.

LPA reviewed documentation of a resident who had been admitted on 10/10/23. Assessment records indicate that the resident (R1) had a mental health diagnosis and deaf, but able to communicate and easy-going. Based on the assessment tools and information provided by medical personnel, the client was admitted to facility. It later became apparent that the assessment did not provide completely accurate information. The carestaff of the facility found it necessary to call 911 due to behaviors of R1 causing staff and residents to feel unsafe. R1 was removed from facility and placed in a more suitable setting.

LPA reviewed the regulation: Acceptance and Retention Limitations: 87455(c)(3)(A) which states (c) No resident shall be accepted or retained if any of the following apply (3) The resident's primary need for care and supervision results from either: (A) An ongoing behavior, caused by a mental disorder, that would upset the general resident group.

Administrator is aware of the facets of regulation 87455 and will adhere to them.

No citations issued.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2023
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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