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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486800936
Report Date: 11/15/2024
Date Signed: 11/15/2024 02:10:21 PM

Document Has Been Signed on 11/15/2024 02:10 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:MC KINLEY CARE HOME #2FACILITY NUMBER:
486800936
ADMINISTRATOR/
DIRECTOR:
MCKINLEY/EVANSFACILITY TYPE:
735
ADDRESS:336 SAWYER STREETTELEPHONE:
(707) 557-4053
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY: 6CENSUS: 5DATE:
11/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:33 PM
MET WITH:Barbara McKinley (Administrator)TIME VISIT/
INSPECTION COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an annual required inspection and met with Licensee/Administrator Barbara McKiinley. Required postings observed.

LPA/Administrator toured the building and grounds which was found clean and in good repair. LPA observed all walkways and exits to be unobstructed. The facility was a comfortable temperature and well lit. There is a sufficient supply of hygiene products and linens on hand for client use. Rooms have the required furnishing. Water temperature in resident's bathrooms measured at 105.4 degrees F which is within Title 22 acceptable regulation range of 105 to 120 degrees F. Toxins were observed key locked in the garage. Facility has at least 2 days of perishable and one week of non-perishable food. Refrigerator was observed clean and food was observed to be stored properly. Medications were centrally stored and locked. Fire extinguisher was last inspected February 6, 2024. Smoke detectors and carbon monoxide detector were tested and functional. Annual fees are current.

LPA reviewed five client and two staff records. All clients have current medical assessments, needs and service plan. Staff records have current CPR/1st aid certificates and training hours completed. Administrator Certificate for Barbara McKiinley #6023425735, expires on 12/15/2024. Medication and medication records were reviewed. Cash resources were reviewed. Administrator provided copies of the following documents: LIC 500 Personnel Report, LIC308 Designation of facility responsibility.

Administrator agreed to submit the following document by not later than 11/22/24: surety bond.

No deficiencies during today's visit. Exit interview was conducted with Licensee and a copy of this report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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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