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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803868
Report Date: 09/07/2023
Date Signed: 09/07/2023 12:19:26 PM


Document Has Been Signed on 09/07/2023 12:19 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: DATE:
09/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Ron-Mark Adriano, House ManagerTIME COMPLETED:
12:25 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an Annual inspection at approximately 09:50 AM, and met with House Manager Ron-Mark Adriano. LPA also contacted Licensee Bob Coleman upon arrival. There were 3 residents and 2 staff at the time of inspection.

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. LPA confirmed licensee has necessary PPE equipment and supplies to support a resident in isolation.

Toxins are secured and inaccessible in locked 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.
2 Fire extinguishers were last serviced on 04/14/2023. Carbon Monoxide Detector was tested and operational. All exterior doors were alarmed and operational. There was an ample supply of fresh and non-perishable foods, all stored as per regulation.

There were no deficiencies found at the time of inspection. No citations issued.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill NakagawaTELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2023
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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