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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 236801775
Report Date: 12/19/2024
Date Signed: 12/19/2024 01:22:18 PM

Document Has Been Signed on 12/19/2024 01:22 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:EQUINOX CARE FACILITY LLCFACILITY NUMBER:
236801775
ADMINISTRATOR/
DIRECTOR:		AJEL, AGNESFACILITY TYPE:
740
ADDRESS:38281 S HWY 1TELEPHONE:
(707) 884-4061
CITY:GUALALASTATE: CAZIP CODE:
95445
CAPACITY: 9CENSUS: 8DATE:
12/19/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Agnes AjelTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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At approximately 11:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to continue the 1 Year required annual inspection. LPA met with Administrator Agnes Ajel and reviewed records. LPA observed 5 staff present during this inspection.
LPA reviewed 5 of 5 staff records and found all to contain evidence of required annual training and current first aid/CPR certifications. All other required documents were present. Administrator certificate expired on 11/4/2024 but all required training has been completed and the renewal application has been submitted on time.
At approximately 12:00PM, LPA reviewed 6 of 8 resident records and found all to contain the required documents. Care plans have all been updated within the last 12 months. All physician assessments are current. Admission agreements are present and signed by both parties. Residents receiving hospice services have a hospice care plans on file.

At approximately 1:00PM, LPA discussed the facilities evacuation plan with the Administrator. Facility will review their procedures and update as needed.

No citations issued during today's visit.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
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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