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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804008
Report Date: 01/23/2024
Date Signed: 01/23/2024 03:23:50 PM


Document Has Been Signed on 01/23/2024 03:23 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:ALF SANCTUARY ADULT RESIDENTIAL CAREFACILITY NUMBER:
486804008
ADMINISTRATOR:MARIA BUNAFACILITY TYPE:
740
ADDRESS:521 SARAH WAYTELEPHONE:
(559) 303-7020
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY:6CENSUS: 5DATE:
01/23/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:01 PM
MET WITH:Rayna Yu, Lead StaffTIME COMPLETED:
03:30 PM
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On 1/23/2024, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of following up on a previous fire clearance visit and confirming staff are not residing in the shed located in the backyard of the facility. LPA and Lead Staff, Rayna Yu toured the facility backyard and shed confirming no current use of the added building for staff living quarters. The facility is currently in the process of planning additional renovations to the shed for city approval. At this time staff who work overnight shifts and require sleeping quarters are utilizing a vacant resident bedroom located inside of the house. LPA observed a staff resting in the vacant bedroom while staff was not on duty.

Administrator to contact LPA if and once plans continue for renovations and contact with the city to complete the use of the additional staff living quarters.

No deficiencies cited during today's visit.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Dominic TobolaTELEPHONE: (707) 588-5081
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2024
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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