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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480109151
Report Date: 05/29/2024
Date Signed: 05/31/2024 01:26:34 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/31/2024 01:26 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/
DIRECTOR:
MC KINLEY, BARBARAFACILITY TYPE:
735
ADDRESS:186 KEMPER STREETTELEPHONE:
(707) 557-2152
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY: 6CENSUS: 2DATE:
05/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Aliyah Evans, House ManagerTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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On 5/29/2024, Licensing Program Analyst (LPA) Jill Nakagawa conducted an unannounced Annual Required- 1 yr. Inspection for this facility and was greeted by DSP Diara Landers. House Manager Aliyah Evans showed up shortly to conduct tour. The facility currently provides care for two clients, both had just returned from their Day Program at the time of inspection.LPA toured the facility with Aliyah Evans; facility was found to be clean and at a comfortable temperature. Client's bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 5/20/2023 and is due to be inspected by the end of this month. There was a sufficient
supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were stored properly as per regulations on this day at the time of the visit. There was a
supply of linens, hygiene products and paper products available for clients located in the hallway. Clients' bedrooms have lighting & appropriate furnishings with bedrooms well maintained and cleaned by staff. Bathrooms had new toilets installed, however toilet seat in bathroom 2 was loose and caulking in shower of
bathroom 1 needs cleaning or replacement. LPA conducted a file review for all clients and found documentation including medical assessments and individual program plans updated and in place. LPA conducted a review of all staff files and found staff to have updated 1st Aid & CPR certification and Direct
Support Professionals training on file. Facility conducts and records fire and disaster drills every month for all staff and clients. A storage shed located in the backyard was found to be secured. LPA found that the screen
sliding door leading to the backyard is in need of replacing due to damage from client behavior. House manager to submit proof of repairs by 6/15/2024.
No citations issued at the time of this inspection.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024
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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