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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 125000780
Report Date: 05/05/2023
Date Signed: 05/05/2023 10:10:43 AM

Document Has Been Signed on 05/05/2023 10:10 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:HALO HAVENFACILITY NUMBER:
125000780
ADMINISTRATOR:ISAAC, LINDAFACILITY TYPE:
735
ADDRESS:2434 D STREETTELEPHONE:
(707) 445-0136
CITY:EUREKASTATE: CAZIP CODE:
95501
CAPACITY: 4CENSUS: 2DATE:
05/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Linda IsaacTIME COMPLETED:
10:25 AM
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At approximately 8:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an Annual Required inspection of this facility and met with Administrator Linda Isaac. At approximately 8:15AM, LPA toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. The amount of fresh and non-perishable foods was within regulation. Toxins are secure and not accessible to clients. Medication is centrally stored and secure. There is a sufficient supply of hygiene products and linens on hand for client use. Mattress pads were in place or available for Client use. Water temperature measured within regulation between 105 and 120 degrees F at faucets accessible to clients. Fire extinguishers inspected were charged. Smoke detectors were tested and found to be in working order. Carbon Monoxide detector was present. Disaster Drills are conducted monthly with the last drill conducted 5/5/23. Facility has a generator to provide power in the event of an outage.

At approximately 8:45AM, LPA reviewed 2 of 2 Client records, which were found to be well organized, thorough and contained the required documentation. Staff First aid and CPR certification were current in staff files reviewed. Facility does not handle P&I monies. Administrator's Certificate was current.

No citations issued during this visit.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2023
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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