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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 236801013
Report Date: 07/08/2021
Date Signed: 07/08/2021 02:28:25 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:ROMES CARE FACILITY IFACILITY NUMBER:
236801013
ADMINISTRATOR:ALCASID, CHRISTINAFACILITY TYPE:
740
ADDRESS:1127 SOUTH DORATELEPHONE:
(707) 468-5986
CITY:UKIAHSTATE: CAZIP CODE:
95482
CAPACITY:6CENSUS: 1DATE:
07/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Licensee Eliseo AlcasidTIME COMPLETED:
02:40 PM
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Licensing Program Analysts (LPAs) Shannan Hansen & Chris Arnhold conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility and was welcomed by Licensee Eliseo Alcasid. There was 1 resident present at the facility of a max capacity of 6.

All staff are temperature checked and logged each shift. LPAs toured the facility with Eliseo Alcasid. During our tour on 7/8/2021, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers were found to be last charged on 7/2020 at the time of the visit. Smoke Detectors & 1 Carbon monoxide detector was found to be operational during the visit. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was a supply of cleaners, hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. Toxins and other cleaning supplies are stored in locked cabinet in laundry room.

Infection Control:

Facility has submitted a mitigation program plan that has been approved. Posters have been placed at facility. Facility has PPE supply stored in a locked closet by laundry room that also contains toxins. Residents do not wear masks inside the facility.

In addition, fully vaccinated visitors visit in resident’s room. Resident has available Face time and telephone calls when contacting with family members and others.

No citations issued.

SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Shannan HansenTELEPHONE: 707-588-1410
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021
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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