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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804190
Report Date: 08/07/2024
Date Signed: 08/07/2024 04:38:38 PM

Document Has Been Signed on 08/07/2024 04:38 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:
08/07/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Randy Lauron-ApplicantTIME VISIT/
INSPECTION COMPLETED:
04:55 PM
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Licensing Program Analyst (LPA) Alviso arrived to conduct a case management inspection to follow-up on needed corrections from the pre-licensing visit of 6/17/24; LPA was greeted by applicant, Randy Lauron, of R and R Care Home, LLC. Randy Lauron will be the facility's Administrator.

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 inspected the facility and observed that all items listed in the pre-licensing report dated 6/17, were done/completed.

The LPA will send the facility evaluation report to the application unit analyst, on 8/8/24, that is processing the applicant's application. The application analyst will notify the applicant of the status of the application.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2024
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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