<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804042
Report Date: 07/26/2022
Date Signed: 07/26/2022 11:56:55 AM

Document Has Been Signed on 07/26/2022 11:56 AM - 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:BICKFORD HOMEFACILITY NUMBER:
486804042
ADMINISTRATOR:CORSIGA, ALMAFACILITY TYPE:
740
ADDRESS:5083 BICKFORD CIRCLETELEPHONE:
(707) 344-2628
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 4CENSUS: 0DATE:
07/26/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Alma Corsiga, Administrator.TIME COMPLETED:
12:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Karina Canela arrived for the purpose of a Post-Licensing inspection and met with Alma Corsiga, Administrator. LPA verified staff's vaccination status during this visit.

The facility currently does not have residents in care.

During today’s visit LPA observed the following items:
· COVID-19 screening station with visitor log, thermometer, hand sanitizer and face masks.
· Lockable separate cabinets for medications, toxins/cleaners, and knives.
· All exits were unobstructed
· 10 hardwired smoke detectors and 2 carbon monoxide detectors, which were tested & observed operational
· Complete first Aid kit, night-lights, and flashlights for emergency lighting
· Supply of paper products available
· Grab bars in the bathroom and non-slip mat in shower.
· Auditory devices observed operational
· Fire Extinguisher charged and serviced 02/15/2022
· Administrator Certification (expires 12/12/2023); Required postings (Personal Rights, Emergency plan/numbers, CCLD "Let Us Know" complaint poster, Emergency Disaster Plan, Resident personal rights.
No deficiencies cited during today's inspection
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Karina Canela
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2022
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