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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804081
Report Date: 08/01/2024
Date Signed: 08/01/2024 12:06:15 PM

Document Has Been Signed on 08/01/2024 12:06 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:EMERALD HOMEFACILITY NUMBER:
486804081
ADMINISTRATOR/
DIRECTOR:
BUNYI, LEONILAFACILITY TYPE:
740
ADDRESS:305 KEYES CT.TELEPHONE:
(510) 421-4182
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY: 5CENSUS: 3DATE:
08/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:37 AM
MET WITH:Leonila Bunyi (Administrator)TIME VISIT/
INSPECTION COMPLETED:
12:21 PM
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a Required 1 Year annual inspection and met with Administrator, Leonila Bunyi. Annual fees are current. Required postings were observed. Contact information was reviewed.

LPA/Administrator toured the facility and observed the following: the facility was clean and at a comfortable temperature with all exits free from obstruction. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Toxins were secure and not accessible to residents. There is a sufficient supply of hygiene products and linens. Bedrooms furnished per regulation. Water temperature measured 108.5 and 110.1 which is within regulation. Medication was centrally stored and secure. Cash resources records were reviewed. Last disaster drill conducted on 7/6/24. Fire extinguishers were charged and serviced on April 2024. Smoke detectors and carbon monoxide detectors were tested and operational. Perishable and non-perishable foods are within regulation.

LPA conducted file review of three residents and three staff files. Clients medical assessments and care plans were updated. One out of three staff do not have a current CPR/1st aid certificate (technical violation was issued). Staff have 20 hours of additional training were complete. Administrator certificate for administrator Leonila Bunyi #7033416740 expires on 10/20/24.

Administrator agreed to submit the following documents by 8/9/24: Designation of Facility Responsibility (LIC 308), Personnel Report (LIC 500), Liability Insurance and surety bond.
No deficiencies cited during today's inspection. Exit interview conducted with Administrator and copy of this report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2024
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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