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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804307
Report Date: 03/05/2025
Date Signed: 03/05/2025 05:45:03 PM

Document Has Been Signed on 03/05/2025 05:45 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:TRANQUILITY LIVING LLCFACILITY NUMBER:
486804307
ADMINISTRATOR/
DIRECTOR:
TANNER, ERICFACILITY TYPE:
740
ADDRESS:118 FAIRFAX COURTTELEPHONE:
(801) 209-7011
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY: 6CENSUS: 0DATE:
03/05/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Eric Tanner, ApplicantTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Pre-Licensing Inspection, for this change of ownership application. LPA was greeted by Applicant/Administrator, Eric Tanner.

This facility received Fire Department clearance approval on 2/7/2025 for a total capacity of 6 non-ambulatory residents, of which 4 residents have an approval for Hospice services. LPA conducted a walk-through of the facility and observed, facility is a single story house with 4 resident bedrooms, 1 staff room, 2 bathrooms, common areas and garage. Resident rooms are furnished per regulation with a bed, lamp, dresser, and bedside table. Bathroom showers have non-skid shower mats and grab bars. There was a locked area for medications and for resident and personnel files. Perishable and non-perishable foods observed and applicant understands food requirements per regulation. The laundry area is located in garage and it has a locked cabinet to secure toxins & cleaning supplies. Water temperature is within regulation of 105 to 120 degrees. Facility backyard has covered area for visiting and activities. The outside shed is locked with pad lock. Facility has emergency lighting in hallways and an emergency flashlights. First Aid Kit is available. Facility has working fire alarms, carbon monoxide and the extinguisher was charged and serviced on July 22, 2024. Facility states and understands the fireplace will not be used and it is locked.

Pre-licensing is complete and there are no deficiencies or corrections needed.

The Component III Orientation was completed with applicant during this visit.

LPA will submit the pre-licensing application report to Application Unit Analyst in Sacramento. Application Unit Analyst will notify applicant of application status.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Araceli Canela
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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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