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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804191
Report Date: 01/23/2024
Date Signed: 01/23/2024 12:36:38 PM

Document Has Been Signed on 01/23/2024 12:36 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:FARMSTEAD AT DIXON, THEFACILITY NUMBER:
486804191
ADMINISTRATOR:REYES, ALANAFACILITY TYPE:
740
ADDRESS:350 GATEWAY DRIVETELEPHONE:
(707) 592-1157
CITY:DIXONSTATE: CAZIP CODE:
95620
CAPACITY: 86CENSUS: 0DATE:
01/23/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Alana Reyes, Administrator TIME COMPLETED:
12:40 PM
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Document Link IconLicensing Program Analyst (LPA) Jill Nakagawa arrived on 01/23/2024 at approximately 9:30 AM to conduct a pre-licensing inspection at The Farmstead at Dixon and met with Alana Reyes (AR), Administrator and Jason Reyes (JR), Licensee.

LPA toured the facility and grounds with AR, JR and staff members. The facility is a new facility, beautifully appointed with spacious surroundings for residents and guests. It will serve independent living, assisted living and memory care. Fire inspection was completed on 01/05/2024 and approves 76 non-ambulatory and 10 bedridden. Fire extinguishers current. Delayed egress has been approved for the exit doors in Memory Care. CCL has a copy of the fire report and facility floor plan.

LPA reviewed administration, food service, medication, activities and their schedule, and physical plant. LPA toured the kitchen and observed sufficient emergency food and water and non-perishable food. All appliances working; kitchen and dining area stocked with sufficient supplies. Facility will prepare all food in main floor kitchen and transport food to memory care kitchen to be served by dining staff. The facility has several areas for residents to socialize and enjoy snacks through out the day, with a gelato bar and a bistro area with made to order pizza.

Continued on 809-C
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
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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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: FARMSTEAD AT DIXON, THE
FACILITY NUMBER: 486804191
VISIT DATE: 01/23/2024
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Continued from 809

Resident bedrooms were completed but unfurnished, except for models, as residents will bring their own furnishings. Memory Care will be on second floor and have safety features on windows and doors, including delayed egress at exits.

First aid supplies are adequate. There was an ample supply of PPE and isolation carts were set up and ready to use, if necessary. Hot water was tested at multiple sites and found to be off by 2 degrees in 2 areas. Maintenance adjusted the hot water to be in range. Maintenance will continue to monitor.

LPA reviewed records for future residents and staff and found them to be in order and stored appropriately and securely. Medication rooms on first and second floor are well-organized and secure.

Component lll was completed successfully. Information regarding resident rights and complaints displayed as required. Proof of liability insurance was provided to LPA.

No deficiencies noted at this time. Facility is ready for final approval by Licensing Unit.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
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
LIC809 (FAS) - (06/04)
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