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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480111474
Report Date: 06/13/2024
Date Signed: 06/13/2024 02:13:39 PM

Document Has Been Signed on 06/13/2024 02:13 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:Q & Q FAMILY CARE HOMEFACILITY NUMBER:
480111474
ADMINISTRATOR/
DIRECTOR:
QUINN, LONDAFACILITY TYPE:
735
ADDRESS:2717 TENNESSEE STREETTELEPHONE:
(707) 644-5303
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY: 5CENSUS: 3DATE:
06/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Londa Quinn, Administrator/LicenseeTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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At approximately 9:00AM, Licensing Program Analyst (LPA) Stefanie Mutialu conducted an unannounced Annual Required inspection to this facility and met with Londa Quinn, Administrator. LPA and Administrator toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. The amount of fresh and non-perishable foods was within regulation. Toxins are secure and not accessible to clients. Medication is centrally stored and secure. There is a sufficient supply of hygiene products and linens on hand for client use. Three out Three clients rooms were inspected and found to be within regulation. Each of clients room is decorated and color coordinated to clients preference Mattress pads were in place or available for Client use. Water temperature did not measure within regulation @ 120 degrees F at faucets accessible to clients. Administrator will lower temperature and provide proof. Six out of six smoke/carbon monoxide detectors were tested and found to be in working order. One out of one fire extinguishers were fully charged. Disaster Drills are conducted quarterly with the last drill conducted 03/04/2024.

At approximately 11:15 AM, LPA reviewed three of three Client records and two of two Staff records, which were all found to be well organized, thorough and contained the required documentation. First aid and CPR certification were current in staff files reviewed. P&I monies were documented, secure and not commingled. Administrator, Londa Quinn, Administrator's Certificate 60263553735/7008122735 is current.


Continued on 809C
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Stefanie Mutialu
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: Q & Q FAMILY CARE HOME
FACILITY NUMBER: 480111474
VISIT DATE: 06/13/2024
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Continued from 809

No citations issued during today’s visit


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

Surety Bond
LIC500- Personnel Report
LIC- 9020 Client Roster
LIC308- Designation of Responsibility
LIC610D- Disaster Plan (Updated with non-local site)



SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Stefanie Mutialu
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC809 (FAS) - (06/04)
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