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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804190
Report Date: 06/17/2024
Date Signed: 06/17/2024 01:15:15 PM

Document Has Been Signed on 06/17/2024 01:15 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:HEATH HOME CAREFACILITY NUMBER:
496804190
ADMINISTRATOR/
DIRECTOR:
LAURON, RANDYFACILITY TYPE:
735
ADDRESS:4568 HEATH CIRCLETELEPHONE:
(650) 288-8935
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 4CENSUS: 0DATE:
06/17/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Randy Lauron-ApplicantTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Alviso arrived to conduct a Pre-Licensing inspection, at approximately 9:10am on 6/17/24, and was greeted by applicant, Randy Lauron, of R and R Care Home, LLC. Randy Lauron will be the facility's Administrator. Component III orientation was completed today, 6/17/24 with applicant, Randy Lauron.

Facility has received a fire clearance approval from the local fire department- effective 9/27/23, for four (4) ambulatory clients. Rooms #1 & #2 are private, and room #3 is a shared room. Fire extinguisher, one (1) was observed to be in the green area, meaning it is fully pressurized. Facility has four (4) smoke alarms which includes carbon monoxide detection; All smoke alarms & CO checks were working appropriately as required. Facility has submitted a required infection control plan. Facility has submitted a required emergency disaster plan.

LPA conducted a walk through of the home that will serve four clients once licensed. LPA observed the following: Facility had a first aid kit, including the first aid guide book. The facility had furnishings for resident use. The physical plant inside the home had all exits clear, and inside walkways were free and clear. The backyard had a deck with patio furnishings for resident use, and an awning that rolls out when needed for partial shade on the deck. Medications will be stored in a locked cabinet in the kitchen. The garage has cabinets for locking up cleaners/disinfectants and making them inaccessible. Applicant has an SUV vehicle that will be used to transport clients as needed. Per applicant, the vehicle has appropriate car insurance, vehicle is in good operating condition, and all seat belts work appropriately. Applicant has a first aid kit for the vehicle.

Items needing to be corrected, see the following:
Hot water temperature was checked at 141.2 degrees Fahrenheit; This temperature is not within regulation, turn down the water heater. Ensure hot water is no lower than 105.degrees Fahrenheit and no higher than 120. degrees Fahrenheit.
Continued on LIC809C....
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: HEATH HOME CARE
FACILITY NUMBER: 496804190
VISIT DATE: 06/17/2024
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Cleaners/Disinfectants were in unlocked cabinets and in an unlocked outside shed, leaving them accessible to all. Lock all cleaners/disinfectants, and any items posing a risk to future clients in care, ensuring they are inaccessible.

Each client room was furnished with most of the required items per regulation; Each client room needs a light/lamp that gives sufficient lighting for the client's use. Two of the rooms need dressers for the storage of client's clothes, room #1, and room #3. Room #1 had two (2) beds in it, but is fire cleared for one (1) resident; The applicant will remove the extra bed out of resident room #1.

Both bathrooms need garbage cans with tight fitting lids. Both bathrooms need to have the sinks and showers cleaned. Each bathroom needs paper towels for client use. Applicant needs to have a sufficient supply of hygiene products for client use. Applicant needs to ensure a sufficient supply of linens for each client, including bedding, blankets, sheets, mattress covers, washcloths, and bathing towels. Sufficient supply of personal protective equipment (PPE).

The outside walkway to the fire exit was observed to be blocked by large tiles, and miscellaneous items; The fire gate opened but not all the way due to the garbage cans lined up stopping the gate from swinging all the way open, needs to be clear and unobstructed. The backyard had some debris and some cleaning to be completed, all tools and items laying around to be stored appropriately, including plant caging that was laying across the yard. Water hose needing to be stored out of the way, ensuring walkways and stairs are clear and unobstructed at all times.

The LPA observed no emergency supplies, and no non-perishable food items. The LPA observed that the kitchen appliances, items on the counter, and the stove, were dirty and greasy, needing to be cleaned. The LPA observed the refrigerator/freezer to be dirty and needing to be cleaned inside and outside.

LPA observed that the dining room table have six (6) chairs, two older chairs were observed to be ripped and peeling, one chair more than the other. The front door area needed to be cleaned of debris and spider webs. The outside backyard deck area and shed needed to cleaned of debris and spider webs.

The LPA obtained pictures of items discussed, mentioned in the report for corrections, during the inspection.
The applicant will notify the LPA when the above items are corrected and completed; The LPA will return to conduct a second inspection. Applicant stated their understanding of the above.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2024
LIC809 (FAS) - (06/04)
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