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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803959
Report Date: 01/10/2025
Date Signed: 01/10/2025 01:33:48 PM

Document Has Been Signed on 01/10/2025 01:33 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:SPECIAL CARE 2FACILITY NUMBER:
486803959
ADMINISTRATOR/
DIRECTOR:		AUJLA, HARJITFACILITY TYPE:
735
ADDRESS:436 AMBER DRIVETELEPHONE:
(707) 981-1987
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY: 4CENSUS: 3DATE:
01/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Manjinder Aujla, Licensee and
Bhupinder Singh, DSP		TIME VISIT/
INSPECTION COMPLETED:
01:40 PM
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On 01/10/2025, Licensing Program Analyst (LPA) Jill Nakagawa, arrived at the facility unannounced to conduct a 1-Year Required Annual Inspection. LPA met with Licensee Manjinder Aujla and Bhupinder Singh, DSP and explained the purpose of the visit.

LPA Nakagawa and staff toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, and common restrooms. LPA observed the facility to be clean, in good repair and odor-free. Each bathroom to have the necessary grab bars, non-skid flooring, paper towels, trash can. LPA observed each bedroom to have the necessary furnishings with working lights and windows with screens.

Facility has a 2-day perishable and a 7-day non-perishable amount of food and sharps to be locked. Hot water temperature was measured within the required range. LPA observed fire extinguisher last serviced on 01/08/2025 and fully charged. Fire detectors and carbon monoxide detectors were installed throughout the facility and functioning at the time of inspection. Last fire drill was conducted on 11/01/2024. LPA observed the first aid kit to be complete and ready for use. The outside of the house was well-maintained and free of debris. Back yard included a shaded area and activities: basketball and a trampoline, gardening area.

In the areas toured no immediate health, safety, or personal rights violations were observed.

LPA reviewed a total of three (3) residents' files and five (5) staff files which contained all the required documentation.

Several topics were discussed.

No deficiencies are being cited as a result of today’s inspection.

Exit interview conducted and copy of report left at the facility.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2025
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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