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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804021
Report Date: 01/26/2023
Date Signed: 01/26/2023 02:32:53 PM

Document Has Been Signed on 01/26/2023 02:32 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: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:
01/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Administrator, Jennifer LandasTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Walk of Life Residential Care ARF for the purpose of conducting a Required 1 year inspection. LPA was greeted at the door by Administrator, Jennifer Landas, and was granted access into the facility. Currently, the facility census is 0 and that there is no staff members hired for this facility.

LPA and Administrator toured the facility on this date and time. LPA observed the facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be last charged on January 2023 at the time of the inspection. Both first aid kits were inspected and found to be appropriate during the inspection. Smoke detectors and carbon monoxide detectors sound directly to the fire station. Water temperature in 3 out of 3 clients bathroom measured at 112 degrees, within acceptable range of 105 to 120 degrees F. There was sufficient perishable and non-perishable foods located in the kitchen. There will be special provisions made for individuals with special dietary needs. Food menu was presently available for viewing during the inspection. Activity menu was also present during the inspection. LPA observed where medications will be centrally stored and locked. Currently, there are no medications centrally stored and locked. Cleaning products and other toxins are located in the laundry room that will be locked. There was a supply of linens, cleaners, hygiene products and paper products available for clients. All bathrooms designated for clients in the common areas at the facility were supplied with individual paper towels and hand soap. Bathrooms in resident’s rooms have a towel and soap. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. A tour of all clients bedrooms were conducted, and bedrooms inspected have lighting and appropriate furnishing.

LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Facility has PPE which is stored in both closets. Currently, there is no staff at the facility for N95 Fit testing as they have no clients in care. (Report continued on LIC 809C)
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: WALK OF LIFE RESIDENTIAL CARE ARF
FACILITY NUMBER: 486804021
VISIT DATE: 01/26/2023
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LPA requested the following documents to be sent:

LIC 500- Personnel Report
LIC 308- Designation of Responsibility
LIC 309- Administrative Organization
LIC 400- Affidavit regarding Client Cash Resources
Updated facility sketch
Updated Emergency Disaster Plan (LIC 610D)
Surety Bond
Most up-to-date Liability insurance
Control of Property

No register of clients necessary as the facility does not have clients in care at this time.

No deficiencies were observed or cited during today's Required 1 year inspection. Exit interview was conducted and a copy of this report given to the Administrator.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
LIC809 (FAS) - (06/04)
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