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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486800150
Report Date: 06/20/2024
Date Signed: 06/20/2024 02:07:42 PM

Document Has Been Signed on 06/20/2024 02:07 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:GRIFFIN FAMILY CARE HOME - BERKELEYFACILITY NUMBER:
486800150
ADMINISTRATOR/
DIRECTOR:		GRIFFIN, EDWARD & JOETTAFACILITY TYPE:
735
ADDRESS:673 BERKELEY WAYTELEPHONE:
(707) 422-8423
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 6CENSUS: 6DATE:
06/20/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:25 PM
MET WITH:Elaine Villalobos, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct this Case Management Visit to amend a report originally dated 06/13/2024. LPA met with Elaine Villalobos, Administrator and Gabriela Echevarria, General Manager.

On June 13, 2024 LPA issued incorrect citations for the handling of cash resources, auditory alarms, and an infection control plan. After further record review and conversations with Licensing Program Manager (LPM), LPA has returned to amend (LIC809 and LIC809Ds) and remove citations due to the facility within compliance.

No citations were issued during this visit.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
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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