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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480111474
Report Date: 07/14/2022
Date Signed: 07/14/2022 12:43:26 PM

Document Has Been Signed on 07/14/2022 12:43 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:Q & Q FAMILY CARE HOMEFACILITY NUMBER:
480111474
ADMINISTRATOR:QUINN, LONDAFACILITY TYPE:
735
ADDRESS:2717 TENNESSEE STREETTELEPHONE:
(707) 644-5303
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY: 5CENSUS: 4DATE:
07/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Londa Quinn, 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
Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. Infection Control inspection for this facility and met with Licensee, Londa Quinn (LQ).The facility currently provides care for 4 clients all of which were present at the time visit. Clients attend day program on Monday and Tuesday with transportation services in place.

LPA arrived at the facility and had temperature checked and logged. LPA continued with a tour of the facility with Licensee; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Client’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 9/13/2022 at the time of the visit. Carbon monoxide detector was located in the hallway and found to be in working order. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored in a locked designated closet and storage unit located in the backyard. There was a supply of cleaners, hygiene products and paper products available for clients. All clients bedrooms have lighting & appropriate furnishings.

Infection Control:
Facility has not yet submitted Infection Control Plan. Licensee agrees to complete plan and submit to CCLD by 7/21/2022. All clients and staff are vaccinated with no symptoms. Posters are readily available to staff and clients for COVID procedures, and facility has a station at main entrance for screening, hand sanitizer and other items designated for visitors and staff. Staff and clients are observed for symptoms and temperature on daily basis.

No deficiencies cited during today's visit.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2022
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