<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480109151
Report Date: 05/20/2022
Date Signed: 05/20/2022 12:53:50 PM

Document Has Been Signed on 05/20/2022 12:53 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:MC KINLEY CARE HOMEFACILITY NUMBER:
480109151
ADMINISTRATOR:MC KINLEY, BARBARAFACILITY TYPE:
735
ADDRESS:186 KEMPER STREETTELEPHONE:
(707) 557-2152
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY: 6CENSUS: 5DATE:
05/20/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Barbara McKinley, LicenseeTIME COMPLETED:
01:00 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
On 5/20/2022 LPA Tobola conducted an unannounced Case Management visit and was greeted by Licensee, Barbara McKinley. The purpose of the visit is to discuss staffing concerns and appropriate client placement. LPA is in conversation with Licensee and North Bay Regional Center (NBRC) of both matters. There are currently 5 clients in care, 4 of which were present upon LPA's arrival and 1 of which had returned to the facility later in the visit.

LPA Tobola conducted interviews with Licensee, Barbara McKinley and NBRC Case Worker (CW1) and client (C1). LPA discussed staffing concerns and appropriate staffing ratios. LPA informed by CW1 that additional staffing will be required with C1 returning to the facility. LPA discussed placement plans and staffing support with CW1 and Licensee.

No deficiencies cited during today's visit.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE: DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1