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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803967
Report Date: 05/24/2022
Date Signed: 05/24/2022 03:53:59 PM

Document Has Been Signed on 05/24/2022 03:53 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:LONGSPUR MANORFACILITY NUMBER:
486803967
ADMINISTRATOR:FERNANDEZ, ASHLEYFACILITY TYPE:
735
ADDRESS:1107 LONGSPUR DRTELEPHONE:
(415) 939-4491
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY: 4CENSUS: 4DATE:
05/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:06 PM
MET WITH:Staff, Noel RaceoTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA), Walters arrived unannounced to conduct a Required 1-year annual inspection and was greeted by Staff, Noel Raceo. The Administrator/Licensee, Frances Fernandez arrived later. At the time of inspection there were five staff providing care and supervision for two clients.

There was a sign posted at the entrance of the facility to advise visitors to use a mask. At the entrance of the facility, there was a screening station, complete with a sign in book and temperature gun. Screening question are listed on the sign in sheet. Employees and Clients are screened daily for COVID-19 symptoms, results are documented.

The facility has designated has designated the living room as the visiting area, visitors are also able to visit in client's bedrooms. Staff were engaged in chess and card games with residents. The facility was clean and a comfortable temperature. Staff cleaning schedules are posted in the hallway. The facility common areas are disinfected four times throughout the day and after usage. Staff checkoff task that are already completed. Signs posted throughout the facility to promote social distancing and hand washing. Bathrooms were stocked with hand washing supplies and paper towels.

LPA reviewed staff and client records which indicate that staff and clients have received their vaccines. Vaccine records are stored in client and staff files. Per Administrator/Licensee all staff completed infection control training through Solono County Public Health Nurse. The infection control training including donning and doffing, and disinfection, is documented and on file. LPA and Administrator discussed having staff sign off on training's. Facility has a 30 day supply of Personal Protective Equipment and medication as doctors orders allow for clients.

No deficiencies cited during todays visit.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Katrina Walters
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2022
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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