216803891-9-8-2020-21-AS-CFGS-BT9VYW-20200908165149

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 216803891
Report Date: 08/21/2020
Date Signed: 09/08/2020 04:52:12 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:	MARIN TERRACE		FACILITY NUMBER:	216803891
ADMINISTRATOR:	RIDOLFI, ELEINA		FACILITY TYPE:	740
ADDRESS:	297 MILLER AVE		TELEPHONE:	(415) 388-9526
CITY:	MILL VALLEY	STATE: CA	ZIP CODE:	94941
CAPACITY:	49	CENSUS: 17	DATE:	08/21/2020
TYPE OF VISIT:	Post Licensing	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Eleina Ridolfi - Administrator		TIME COMPLETED:	12:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Fernandes-Goes conducted a tele-visit inspection on 8/21/2020 at 10:30 AM to conduct a post licensing visit. LPA is conducting a tele-visit with Administrator Eleina Rodolfi. The inspection is being conducted by tele-inspection due to COVID-19. The reader is advised that the LPA did not physically make a site visit. Currently there are 16 residents in care. LPA observed auditory device functioning on the front door at the time of the tele-visit. LPA observed facility seem to be clean and with all exits free from obstruction. Exits were equipped with auditory devices. Fire Extinguisher as per licensee was last charged on 1/2020 at the time of the visit. Carbon monoxide detector was tested and found to be operational during the visit. Facility smoke detectors are hard wired and sound directly to the fire station. Smoke detectors and fire sprinklers are inspected annually. Licensee was able to provide LPA with a water temperature reading of 109. degrees F and 110.9 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 2 of 2 resident’s faucets. Facility will monitor the bathroom to ensure compliance. Bathrooms were equipped with necessary grab bars and non-slip floors/mats and appeared to have sufficient hygiene products. The amount of fresh and nonperishable foods appeared to be within Title 22 Regulation. Continue LIC 809-C

SUPERVISOR'S NAME: Carla Martinez	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Carla Fernandes-Goes	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2020

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: MARIN TERRACE	FACILITY NUMBER: 216803891
	VISIT DATE: 08/21/2020

NARRATIVE

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Food stored in the kitchen refrigerator were properly stored as per regulations during tele-visit. Food is available for residents any time of the day. Toxins appeared to be in locked shed and cabinet in the back of the kitchen area. LPA observed required postings (Emergency Preparedness, CCL Complaint poster) and COVID-19 required visitation postings.

LPA and Licensee inspected via tele-visit the back-yard area. In addition, LPA didn’t reviewed files through tele-visit due to no clients in care. LPA reviewed 1 staff record for administrator. Administrator Certificate for Eleina Ridolfi # 6032083740 expired on 8/10/2020. Administrator has submitted documentation to renew. Licensee stated disaster drills are conducted quarterly with the last drill conducted 8/12/2020.

LPA is advising facility to ensure that all residents have an LIC 602, TB test results, care plans; medications and ½ bedrails have doctors orders and are used/given according to these orders. In addition, facility to review and ensure that all staff has been fingerprint cleared and associated to the facility, have 1^st aid/CPR, annual and initial training required, health screening and TB test on file to be reviewed.

No deficiencies cited during today's inspection.

SUPERVISOR'S NAME: Carla Martinez	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Carla Fernandes-Goes	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2020

LIC809 (FAS) - (06/04)

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