<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804021
Report Date: 01/18/2022
Date Signed: 01/18/2022 02:23:43 PM

Document Has Been Signed on 01/18/2022 02:23 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:WALK OF LIFE RESIDENTIAL CARE - ARFFACILITY NUMBER:
486804021
ADMINISTRATOR:LANDAS, JENNIFERFACILITY TYPE:
735
ADDRESS:3124 MUSE WAYTELEPHONE:
(707) 439-1816
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 4CENSUS: 0DATE:
01/18/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jennifer Landas, ApplicantTIME COMPLETED:
02:35 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Karina Canela conducted a pre-licensing inspection on 1/18/2022.
LPA met with applicant Jennifer Landas who will be the Administrator once the facility is approved for licensure. Additionally Alfred Landas, Annabelle Lewis-Barreto and Ruben Poblete were present. The facility has a fire clearance approval from the Fairfield Fire Department of 1 ambulatory, 2 non-ambulatory, and 1 bedridden - for a total of 4 residents. Facility will operate with 24 hour staffing and Licensee will ensure sufficient staffing at all times.
During today’s visit LPA observed the following items:
· COVID-19 postings
· Lockable separate cabinets for medications, toxins/cleaners, and knives.
· All exits were unobstructed
· 7 hardwired combination smoke and carbon monoxide detectors, which were tested and observed operational
· Complete first Aid kit, night-lights, and flashlights for emergency lighting
· Supply of linens, paper products, and hygiene supplies available
· Grab bars in bathrooms.
· Fire Extinguisher charged and serviced 04/14/2021
· Required furnishings in all 4 bedrooms
· Administrator Certifications; Required postings (Personal Rights, Emergency plan/numbers, CCLD complaint poster, and visitor policy).
· The water temperature was tested during inspection and was within regulation of 105-120 Degrees F.

The Component III Orientation was completed. Pre-licensing is incomplete with corrections needed.

** Non-slip mats are needed in 2 of 3 bathrooms. Applicant to send pictures to LPA as proof of correction. Once LPA receives pictures of correction, LPA will submit the pre-licensing application report to the Application Unit Analyst in Sacramento; Application Unit Analyst will notify applicant of application status. No deficiencies cited during this visit

SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Karina Canela
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1