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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 236801013
Report Date: 07/02/2024
Date Signed: 07/02/2024 02:36:55 PM


Document Has Been Signed on 07/02/2024 02:36 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



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:
07/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Elisio AlcasidTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Jacky Macias arrived unannounced to conduct a required Annual inspection and was greeted by Licensee, Eliseo Alcasid. Administrator was not able to be present during the visit.
At approximately 12:45pm LPA and Licensee toured the building and grounds which was found to be clean and at a comfortable temperature. LPA observed all walkways and exits to be unobstructed. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner. Toxins are stored and not accessible. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Client bathroom had required bath mat and grab bar. Water temperature in sink accessible to clients in care measured at 105.2 degrees F which is within the allowable range of 105 to 120 degrees F.
Fire extinguishers were last inspected August 2, 2023. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility has a backup generator for use during a power outage. LPA reviewed the facility emergency disaster plan. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations.
There is currently 1 resident residing at the care home. LPA reviewed Client records which was found to be well organized, thorough and contained the required documentation. LPA reviewed staff records and found evidence of completed training as required and evidence of current first aid and CPR.
At approximately 2:00pm LPA and Licensee conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. No deficiencies

Christina Alcasid, Administrator Certificate 7009931740 expires 2/8/25. All fees are current as of this time.



Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit:

Updated Rental/Lease Agreement
LIC500- Personnel Report
LIC308- Designation of Responsibility
LIC610D- Disaster Plan

No citations issued during this visit. Exit interview conducted
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jacqueline MaciasTELEPHONE: (707) 588-5034
LICENSING EVALUATOR SIGNATURE:
DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2024
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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