216803982-3-25-2022-21-AS-CFGS-CCUT8W-20220325143100

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 216803982
Report Date: 03/25/2022
Date Signed: 03/25/2022 02:31:27 PM

Document Has Been Signed on 03/25/2022 02:31 PM - 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:	ANTON POINTE, THE		FACILITY NUMBER:	216803982
ADMINISTRATOR:	ODIWE, CLEDA M.		FACILITY TYPE:	740
ADDRESS:	1470 SOUTH NOVATO BLVD.		TELEPHONE:	(415) 897-1055
CITY:	NOVATO	STATE: CA	ZIP CODE:	94947
CAPACITY:	10	CENSUS: 7	DATE:	03/25/2022
TYPE OF VISIT:	Post Licensing	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Cleda Odiwe - Licensee/Administrator		TIME COMPLETED:	03:22 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 an unannounced post-licensing infection control inspection to this facility and was welcome by Cleda Odiwe. Facility has 7 residents with 1 under hospice care at this time. LPA arrived at the facility and observed hand sanitizer at the entrance and a log in binder for temperature of visitors. During tour of the facility on 3/25/2022 with licensee/administrator Cleda Odiwe, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Sample tour of resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 06/21. Hot water temperature measured between 113.2 degrees F and 117.3 degrees F in 2 out of 2 resident’s bathroom faucets which are within Title 22 acceptable regulation of 105 to 120 degrees F. Toxins are stored in a locked laundry room. Dangerous items were stored inaccessible to residents in care. There was a supply of cleaners, hygiene products and paper products available for residents. The bathroom designated for residents at the facility were supplied with individual paper towels; hand soap dispenser was available. Sample resident’s bedrooms have lighting & appropriate furnishings. Facility understands that unvaccinated staff must have an exception on file and be tested once a week if PCR. Infection Control: Facility has submitted a mitigation program plan that has been approved at this time. Posters have been placed throughout of facility and entrance. Facility has PPE supply stored in the office and cabinet by entry door. Facility has not hired new staff, however; has admitted new residents since licensed. Resident’s medications are stored and locked in office room. Continue LIC809-C

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Carla Fernandes-Goes	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022

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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: ANTON POINTE, THE	FACILITY NUMBER: 216803982
	VISIT DATE: 03/25/2022

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Facility has a 30-day supply of medication for residents. Residents aren’t wearing masks inside the facility, however; staff stated that they are able to wear masks when going on outings. All staff had masks on during this visit. Facility has acquired N-95 fit testing which is on file for Department to check per licensee/administrator.

There were no deficiencies cited at this time.

Department is requesting the following to be submitted to CCLD by 4/1/2022:
LIC 308
LIC 500
LIC 9020
Copy of Administrator Certificate
Copy of liability insurance

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Carla Fernandes-Goes	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022

LIC809 (FAS) - (06/04)

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