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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216803006
Report Date: 09/14/2021
Date Signed: 09/14/2021 12:13:48 PM

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:TERRA LINDA CHRISTIAN HOMES, INC # 2FACILITY NUMBER:
216803006
ADMINISTRATOR:ANABELLE BAUTISTAFACILITY TYPE:
740
ADDRESS:598 KERNBERRYTELEPHONE:
(415) 479-0266
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY:6CENSUS: 6DATE:
09/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:17 AM
MET WITH:Administrator, David SekirandaTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA), Farhaan Sarangi arrived Unannounced at Terra Linda Chrisitian Homes, Inc #2 for the purpose of conducting a Required 1 year inspection. LPA was greeted at the door by Care Giver, Nario Crisostomo. Administrator, David Sekiranda arrived 20 minutes later.

LPA toured the facility with administrator, David Sekiranda. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be last charged on 04/2021 at the time of the visit. Smoke detectors and carbon monoxide detectors were found to be operational during the visit. Hot water temperature measured at 115 degrees in residents bathrooms. The facility serves residents with dementia and has a plan of operation for special care and programming. There was a sufficient supply of both perishable and nonperishable food as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored in the locked closet in the hallway over laundry. The bathrooms designated for residents at the facility were supplied with individual paper towels and hand soap dispensers instead individual hand towels. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. All bedrooms have lighting & appropriate furnishings. Resident’s beds were outfitted with mattress pads as required by Title 22 Regulations # 87307. LPA requested the following documents be updated and sent to licensing, LIC 309, LIC 400, LIC 308, LIC 500, LIC 402, Facility sketch, liability insurance and updating the facilities Program Plan of Operation.

LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Facility has PPE in the office located and at other sister sites. Facility is in the process of being N95 Fit tested on September 22, 2021.

No deficiencies were observed or cited during today's Required 1- Year inspection. Exit interview was conducted and a copy of this report was emailed to the facility Administrator, David Sekiranda.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5029
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: 707-588-5034
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
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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