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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804219
Report Date: 05/14/2024
Date Signed: 05/16/2024 09:35:54 AM

Document Has Been Signed on 05/16/2024 09:35 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:VIEWMONT COTTAGEFACILITY NUMBER:
486804219
ADMINISTRATOR/
DIRECTOR:
SIMI, ANGELINAFACILITY TYPE:
740
ADDRESS:219 CORKWOOD STREETTELEPHONE:
(707) 287-0118
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY: 6CENSUS: 0DATE:
05/14/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:14 PM
MET WITH:Angelina Simi, Administrator and Michael O'Reilly, co-applicantTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Araceli Canela arrived to conduct a pre-licensing inspection and was greeted by Administrator, Angelina Simi and co-applicant Michael O'Reilly.

At approximately 2:15PM LPA toured the building and grounds. The home is clean, organized, at a comfortable temperature with all exits free from obstruction. Facility is a two story residence with four bedrooms and two bathrooms in the first floor and an additional bedroom (staff) in the upstairs. The main level of the home is made a family room, dining room, kitchen and office. This home has a large bonus room in the yard that will be used by residents for activities and two part garage and storage room. All resident rooms are furnished per regulation with a bed, lamp, dresser, chair and bedside table.

There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Cleaning supplies and toxins are inaccessible to residents under the kitchen sink and sharps will be inaccessible. There was an appropriate supply of linens, hygiene products and paper products available for residents. Required postings were observed.

Facility received an approved fire clearance dated February 23, 2024 by the Vallejo Fire department. Room number #3 may be used by bedridden and the other 3 rooms were approved for non-ambulatory. LPA observed charged fire extinguishers in the main home and outside in the bonus room. Smoke detectors and carbon monoxide detectors were observed. Facility has an Infection Control plan and Emergency Disaster Plan on file. Hot water temperatures found to be 108 degrees and within Title 22 Regulations of 105 to 120.
No Deficiencies given during visit. Pre-Licensing inspection is complete. Component III was conducted with Administrator.
LPA will then submit Pre-Licensing Application Report to the Application Unit Analyst in Sacramento. Application Unit Analyst will notify Applicant of Status
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Araceli Canela
LICENSING EVALUATOR SIGNATURE: DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2024
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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