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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804008
Report Date: 02/03/2022
Date Signed: 02/03/2022 12:03:02 PM

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:ALF SANCTUARY ADULT RESIDENTIAL CAREFACILITY NUMBER:
486804008
ADMINISTRATOR:AQUINO, MARICELFACILITY TYPE:
740
ADDRESS:521 SARAH WAYTELEPHONE:
(559) 303-7020
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY:6CENSUS: 2DATE:
02/03/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Staff Reyna YuTIME COMPLETED:
12:15 PM
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Licensing Program Analysts (LPAs) Willis and Felias arrived unannounced to conduct a Post Licensing Inspection and met with Staff Member Rayna Yu, Administrator Maricel Aquino was available by phone.

Upon arrival, LPAs temperature was checked and documented and LPAs were asked to sign in. LPAs conducted a walk-through of the facility and observed the following: Facility has Covid-19 posters throughout the facility including on the front door and hand washing signs in the bathroom. Facility was a comfortable temperature and exits were free from obstructions. Hand sanitizer was available in common areas. Staff wear masks while in the facility. Observed staff had masks on during this visit. Per conversation with Administrator, Live-in Staff are screened for Covid-19 symptoms at the beginning of their shift and Residents are screened twice a day.

LPAs and Administrator discussed resident activities and visitation. Commonly touched surfaces are disinfected twice per day and as needed..

Facility has at least a 30 day supply of Personal Protective Equipment (PPE) including surgical masks, gloves and hand sanitizer. Staff have been N95 fit tested. Facility maintains a 30 day supply of medication.

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No deficiencies cited during this inspection.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria WillisTELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022
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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