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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490106870
Report Date: 05/20/2022
Date Signed: 05/20/2022 03:00:13 PM


Document Has Been Signed on 05/20/2022 03:00 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:ALL SEASONS RESIDENTIAL CARE HOMEFACILITY NUMBER:
490106870
ADMINISTRATOR:GEORGE AND LISA MELOFACILITY TYPE:
740
ADDRESS:5509 VOLKERTS ROADTELEPHONE:
(707) 829-8109
CITY:SEBASTOPOLSTATE: CAZIP CODE:
95472
CAPACITY:6CENSUS: 6DATE:
05/20/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:29 PM
MET WITH:Lisa Melo (Licensee)TIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a Case Management visit and met with staff, Tammi Marshall. Licensee, Lisa Melo arrived later. LPA/Licensee reviewed PIN 22-07, 22-09, 22-13, 22-15 & 22-16.

During today's visit LPA/Licensee observed that the facility outside deck is under remodel process and construction. The area of the construction in the south side of the facility is accessible to four residents in care, their bedrooms lead to the construction area and doors have caution tape around it and each bedroom has an auditory alarm to alert staff if residents open the sliding doors. There are red cones and no constructions tools were observed in the construction area. Tools and debris was observed by the facility fence located south side of the facility. Per Licensee, the city did not issue a permit because the deck is just being replaced and all the deck construction will be completed by the first week of June 2022.

LPA also reviewed four resident's Physician reports (LIC602) that confirmed that residents don't have a diagnosis of Dementia. LPA discussed with Licensee the importance of resident's safety throughout the construction project. Licensee assured LPA that the construction staff and facility staff will make sure that safety precautions regarding tools, toxins and exposure to safety hazards will addressed daily and while construction crews are on site and after the daily construction work is completed.

No deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022
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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