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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 236800970
Report Date: 01/27/2023
Date Signed: 01/27/2023 09:22:25 AM


Document Has Been Signed on 01/27/2023 09:22 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:OBSERVATORY CARE HOMEFACILITY NUMBER:
236800970
ADMINISTRATOR:CRISTINA ALCASIDFACILITY TYPE:
740
ADDRESS:270 OBSERVATORY STREETTELEPHONE:
(707) 468-5986
CITY:UKIAHSTATE: CAZIP CODE:
95482
CAPACITY:6CENSUS: 3DATE:
01/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Eliseo AlcasidTIME COMPLETED:
09:40 AM
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At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an Annual Required infection control inspection. This inspection will focus on the Infection Control procedures and practices of this facility. LPA met with Licensee Eliseo Alcasid. There were 3 residents present at the facility.

LPA arrived at the facility and had temperature checked and health questions asked. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers were found to be charged and inspected within the last 12 months. Toxins are stored and not accessible. There was a supply of cleaners, hygiene products and paper products available for resident use. There is a supply of extra blankets for resident use.

Facility has submitted an infection control plan. Posters are in place at the entrance and throughout the building. Facility has PPE supplies. Medications are secure and not accessible to residents. Residents wear masks while away from the facility. All staff had masks on during this visit.


There were no deficiencies found in the areas inspected.

No citations issued.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher ArnholdTELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:
DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/27/2023
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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