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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803901
Report Date: 07/08/2024
Date Signed: 07/08/2024 01:04:55 PM


Document Has Been Signed on 07/08/2024 01:04 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 LARAMIE, LLCFACILITY NUMBER:
486803901
ADMINISTRATOR:MANGUIAT, DOUGLASFACILITY TYPE:
740
ADDRESS:512 LARAMIE WAYTELEPHONE:
(707) 592-4004
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY:6CENSUS: 3DATE:
07/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Lourdes Pantig, ManagerTIME COMPLETED:
01:05 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced at approximately 09:30 AM on 07/08/2024 to conduct an Annual Inspection. There were two (2) care staff at the facility and three (3) residents in care at the time of inspection. Facility has an approved dementia plan of operation. There is an approved hospice waiver for six (6). An Infection Control plan was submitted. Fire clearance is approved for six (6) non-ambulatory.

All visitors are asked to screen before entry; temperatures are taken, and information is logged. Facility was found to be clean, orderly, and at a comfortable temperature of 70 degrees F, with all exits free from obstruction. Toxins are stored in locked laundry room. There was a sufficient supply of hygiene products, cleaners, and paper products for use as needed. Medications were stored locked in a hall closet. Exit alarms were on all exit doors and working properly. All 3 bathrooms had grab bars, and non-slip mats/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). There were three (3) fire extinguishers that were last serviced on 9/26/2023 and were fully charged and two (2) carbon monoxide detectors that were operational. There is a central fire alarm system. The last fire drill was conducted in 05/2024.

LPA inspected resident files. Needs and Services Plans were missing in 2 of 3 files inspected. Program Manager will have included in files immediately.

The facility has a backyard with a patio area outfitted with outdoor seating , although there is no shade structure.

Exit interview conducted with Lourdes Pantig, manager.

SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill NakagawaTELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:
DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2024
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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