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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486800558
Report Date: 03/12/2025
Date Signed: 03/12/2025 01:09:21 PM

Document Has Been Signed on 03/12/2025 01:09 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 - UDELLFACILITY NUMBER:
486800558
ADMINISTRATOR/
DIRECTOR:		GRIFFIN, JOETTA AND EDWARDFACILITY TYPE:
735
ADDRESS:4692 UDELL ROADTELEPHONE:
(707) 446-2512
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 6CENSUS: 6DATE:
03/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Gabriela Echevarria, Acting AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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At approximately 9:10 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year inspection. There was no one at the facility when the LPA arrived. LPA phoned acting Administrator (AA) Gabriela Echevarria who arrived at 10:20 AM. Griffin Family Care Home - Udell is Licensed as an Adult Residential Facility (ARF). The facility is a two (2) story house with residents living on both floors. The facility has an approved fire clearance for six (6) ambulatory Clients between the ages of eighteen (18) and fifty-nine (59). Upon arrival, LPA was informed that there were six (6) clients in care. At the time of the Inspection all clients were at day programs. At approximately 10:30 AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation.

At approximately 10:50 AM, LPA toured the facility with AA Echevarria. All exits were clear and unobstructed. Two (2) fire extinguishers were last serviced and tagged on 3/12/2025 Food supply was sufficient. The facility was sufficiently lighted. LPA inspected four (4) client bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for clients. Toxins were observed to be stored inaccessible to clients. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills monthly. The last disaster drill was conducted on 3/1/2025. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for a sample of four (4) sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational.

Continued on 809-C...
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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 2
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: GRIFFIN FAMILY CARE HOME - UDELL
FACILITY NUMBER: 486800558
VISIT DATE: 03/12/2025
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...Continued from 809

At approximately 11:40 AM, LPA reviewed three (3) client files. Three (3) of three (3) client files were found to be well organized and thorough with all required documentation. LPA reviewed three (3) staff files. All staff files were found to be well organized with all required documentation including First Aid and CPR certification and proper training documentation. LPA spot checked Medication for three (3) clients. LPA observed all medications to be centrally stored, secure and with proper documentation.

Acting Administrator Gabriela Echevarria Certification 7000107735 is current with an expiration date of 9/11/2025.

LPA requested the following documents be submitted to Community Care Licensing by 4/12/2025:



LIC 500 Personnel Report
LIC 308 Designation of Responsibility
LIC 610D Emergency Disaster Plan
Proof of Liability Insurance
LIC 402 Surety Bond
LIC 400 Affidavit Regarding Client Cash Resources

No deficiencies cited during today's visit.

Exit interview conducted. Copy of report discussed and provided to AA Echevarria. Signature on form confirms receipt of documents.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC809 (FAS) - (06/04)
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