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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804042
Report Date: 01/24/2024
Date Signed: 01/24/2024 10:58:15 AM


Document Has Been Signed on 01/24/2024 10:58 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:BICKFORD HOMEFACILITY NUMBER:
486804042
ADMINISTRATOR:GLEMAR MELOFACILITY TYPE:
740
ADDRESS:5083 BICKFORD CIRCLETELEPHONE:
(707) 344-2628
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:4CENSUS: 1DATE:
01/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Alma Corsiga - administratorTIME COMPLETED:
11:30 AM
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01/24/2023 10:00 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with Alma Corsiga, Licensee / Administrator ( Admin #486804042 exp.12/12/2023) and explained the purpose of the visit.

LPA Knight and the administrator toured the facility together to ensure the health and safety of residents in care. The facility has two stories with four (4) resident bedrooms and two (2) resident bathrooms on the first floor. The second floor has three (3) staff bedrooms and two (2) staff bathrooms. Areas toured include but are not limited to four (4) resident rooms, common areas, two (2) bathrooms, kitchen, storage areas and back yard. Staff and resident files were reviewed. All employees requiring background checks are cleared. Administrator submitted renewal documents in October 2023 and is waiting for updated certificate. The facility has a hospice waiver for 2 residents.

Bedding, linens, and towels for residents were observed and found to be clean and in good repair. There is an adequate supply of toiletries for the residents. Medication is locked in a cabinet. Medications were reviewed.

The facility was observed to be at a comfortable temperature. Common area was clean and in good repair. All bedrooms had required furniture, bedding, and lighting. Bathrooms were clean, in good repair and contained necessary grab bars and non-slip floors. Kitchen was clean and in good repair. Food appears to be stored and prepared properly. Facility has required (7) seven-day non-perishable and (2) day perishable supply of food. Fire extinguishers fully charged and were inspected in February 2023. Smoke detectors are all operational. No pools/bodies of water are on premises. No firearms are on premises.

LPA requested the following documents to be sent to CCL Santa Rosa office:
LIC 500- Personnel Report
Most up-to-date Liability insurance
Updated lease (exp. 2022)

In the areas toured no immediate health, safety, or personal rights violations were observed. No deficiencies are being cited as a result of today’s inspection.

Exit interview conducted and copy of report was provided to licensee / administrator Alma Corsiga.

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
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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