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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486800558
Report Date: 01/28/2022
Date Signed: 01/28/2022 01:05:06 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:GRIFFIN FAMILY CARE HOME - UDELLFACILITY NUMBER:
486800558
ADMINISTRATOR:GRIFFIN, JOETTA AND EDWARDFACILITY TYPE:
735
ADDRESS:4692 UDELL ROADTELEPHONE:
(707) 446-2512
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY:6CENSUS: 6DATE:
01/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Gabriella EschTIME COMPLETED:
01:15 PM
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On 1/28/2022, Licensing Program Analyst (LPA) Walters arrived unannounced to conduct an Annual/Required 1 Year inspection and was greeted by staff. Administrator Gabriella Echevarria arrived later.

At the time of the inspection all clients were attending day program. This inspection is focused on the infection control of this facility. This facility has already submitted their COVID 19 mitigation plan which was approved by Community Care Licensing on 03/10/21. Facility has developed procedures to test, isolate and quarantine residents.

At the entrance of the facility signs are posted to inform visitors of their visiting policy. Upon entry staff checked LPAs temperature and, went through a symptoms checklist. Hand sanitizer, disposable mask, and N95 mask were available upon entry. There were signs posted throughout the facility, promoting hand washing and social distancing.

LPA observed that there were signs posted informing staff as to how to don and doff. LPA reviewed staff files and found that 4 of 4 staff have been trained on infection control and personal protective equipment. Facility has a way of storing both resident and staff vaccination records. Facility has an appropriate amount of cleaning products. Facility staff disinfect the facility twice daily, and after usage. LPA observed a 30 day supply of Personal Protective Equipment PPE, incontinence products and medications. Medications were centrally stored. Bathrooms were stocked with paper towels and hand washing supplies. Trash cans had lids, to prevent the spread of infectious and airborne illnesses. Administrator and Staff demonstrated their quarantine procedures should resident's develop COVID-19 symptoms.
No citations during today's visit.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Katrina WaltersTELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2022
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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