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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804305
Report Date: 02/26/2025
Date Signed: 02/26/2025 05:06:03 PM

Document Has Been Signed on 02/26/2025 05:06 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:AMITY CARE HOME 2FACILITY NUMBER:
486804305
ADMINISTRATOR/
DIRECTOR:		ALONZO, SHIELAFACILITY TYPE:
735
ADDRESS:133 LARSEN CIRCLETELEPHONE:
(707) 731-0115
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY: 3CENSUS: 0DATE:
02/26/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:05 PM
MET WITH:Sheila Alonzo, Applicant/AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:51 PM
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On 2/26/2025 Licensing Program Analyst (LPA) Araceli Canela arrived to this home to conduct a pre-licensing inspection. LPA was greeted by Applicant/Administrator, Sheila Alonzo. The facility is a 4 bedroom, 2 bathroom, single story house. Three bedrooms and one bathroom are for client use and one bedroom and master bathroom are for staff use. LPA toured the entire premise which was found to be clean and orderly. Fire extinguisher was recently purchased on 5/23/2024. Smoke detectors and Carbon monoxide detector were tested and found to be in working order. Medications, facility files and emergency supplies are stored in a secured closet located in the living room area. Toxins and cleaning supplies are secured in locked cabinets in the kitchen the garage. Sharps and knives are also found to be secured in a locked cabinet in the kitchen.

LPA observed at least a minimum of a 2 day supply of perishable and 7 day supply of non-perishable food necessary for 3 clients. An additional pantry is located in a hallway closet.

Bedrooms have the required furnishings, such as a bed, night stand, chest of drawers, closet space, chair and a lamp. Beds have appropriate linens and home has extra linens available in linen closet. Hot water temperature is within regulation between 105 degrees F and 120 degrees F.

A fire clearance for this home was granted for 3 ambulatory clients, by the Vallejo Fire Department on December 23, 2024.

Component III orientation was conducted with the Applicant/Administrator, Sheila Alonzo.

The pre-licensing evaluation has been completed and there are no corrections needed. LPA will send report to the Application Specialist.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Araceli Canela
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2025
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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