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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216800895
Report Date: 11/15/2021
Date Signed: 11/16/2021 07:34:02 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:ANTON POINTE, THEFACILITY NUMBER:
216800895
ADMINISTRATOR:ODIWE, CLEDA M.FACILITY TYPE:
740
ADDRESS:1470 SOUTH NOVATO BLVD.TELEPHONE:
(415) 897-1055
CITY:NOVATOSTATE: CAZIP CODE:
94947
CAPACITY:10CENSUS: 7DATE:
11/15/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Cleda Odiwe - Licensee/AdministratorTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Fernandes-Goes conducted a case management inspection and met with Licensee/Administrator Cleda Odiwe. This is a change of ownership/pre-licensing visit. LPA conducted a component III orientation with Cleda & Ken Odiwe Administrator/Licensee. There is a total of 7 residents and no residents under Hospice care.

Facility is a one floor facility. LPA toured the facility on 11/15/2021 with Licensee/Administrator Cleda Odiwe; facility was found to be at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be last charged on 06/2021. Sample test of facility smoke detectors and carbon monoxide detectors were found to be operational. Sample hot water temperature measured 111.7 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 1 of 1 resident’s bathroom faucet. The facility has special care plan of operation and programming for residents with dementia. Facility does grocery shopping on Tuesdays. Food stored in the kitchen refrigerator were properly stored as per regulations. LPA observed that provisions are made for individuals with special dietary needs. Food is available for residents any time of the day. Toxins are stored in a locked cabinet in the office room. There was a supply of cleaners, hygiene products and paper products available for residents. All bathrooms designated for residents at the facility were supplied with paper towels and hand soap dispensers. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. A sample tour of resident’s bedrooms was conducted, and bedrooms inspected have lighting & appropriate furnishing.
Facility floor includes kitchen, laundry room, living room area, bathrooms, office room, dining room, and resident's bedrooms, and bathrooms. There is outdoor space for activities. Resident's & Personnel records, medication, first aid supplies, and toxins will be locked in the office. Postings noted to be current and in compliance with guidelines. First aid kit has been placed by medications. PPE is being stored in a supply room. Disaster Drills have been conducted often and in different shifts with the last one being conducted on 7/2021.

There were no deficiencies cited at this time.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Carla Fernandes-GoesTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
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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