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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803901
Report Date: 06/17/2022
Date Signed: 06/17/2022 10:36:48 AM

Document Has Been Signed on 06/17/2022 10:36 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 LARAMIE, LLCFACILITY NUMBER:
486803901
ADMINISTRATOR:MANGUIAT, DOUGLASFACILITY TYPE:
740
ADDRESS:512 LARAMIE WAYTELEPHONE:
(707) 592-4004
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 6CENSUS: 5DATE:
06/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Mel Morrison, CaregiverTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to do an inspection and found five (5) residents in care. LPA was screened for Covid-19 before entry. Two (2) staff were at the facility and both were wearing masks.

The facility was clean and a comfortable temperature. One resident was enjoying a a puzzle and music in the living room. Three residents were resting comfortably in bed, and one was at an appointment. LPA found deficiency from previous visit to be corrected and Covid-19 protocols were being practiced.

No deficiencies were found at the time of this visit.
No citations issued.

Exit interview conducted with Mel Morrison, Caregiver.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2022
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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