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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486800936
Report Date: 12/28/2021
Date Signed: 12/28/2021 01:15:20 PM

Document Has Been Signed on 12/28/2021 01:15 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:MC KINLEY CARE HOME #2FACILITY NUMBER:
486800936
ADMINISTRATOR:MCKINLEY/EVANSFACILITY TYPE:
735
ADDRESS:336 SAWYER STREETTELEPHONE:
(707) 557-4053
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY: 6CENSUS: 3DATE:
12/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Care Giver, Crystal McGriffTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Mc Kinley Care Home #2 for the purpose of conducting a Required-1 year inspection. LPA was greeted at the door by Care Giver, Crystal McGriff, and was granted access into the facility.

LPA began a tour and inspection of the building and grounds which was found to be clean and a comfortable temperature. LPA observed all walkways and exits to be unobstructed. The amount of fresh and non-perishable foods was within regulation. Toxins are secured in a cabinet in the locked garage and not accessible to clients. There is a sufficient supply of hygiene products and linens on hand for client use. Water temperature measured between 105 and 120 degrees F at faucets accessible to clients. There was one fire extinguisher which was last charged July 2021. Smoke detectors were tested and found to be in working order. Carbon monoxide detector was located in client’s hallway and is found to be in working order. Disaster/Fire drills are conducted monthly with the last drill conducted 12/15/2021. Medication is centrally stored in a locked drawer in the living room. First aid kit was appropriate during inspection. LPA requested Facility to update the following documents: Emergency Disaster Plan. LPA also requested the following documents to be sent to the Regional Office, LIC 309, LIC 400, LIC 308, updated facility sketch, LIC 500 and updated liability insurance.

LPAs advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Facility has been N95 Fit tested. PPE is sufficient in the facility. Staff has had training in PPE and COVID-19 by Solano County Public Health.

No deficiencies were observed or cited during today's Required 1- Year inspection. Exit interview was conducted and a copy of this report was emailed to the Facility Administrator.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/28/2021
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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