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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490106870
Report Date: 07/15/2024
Date Signed: 07/15/2024 10:39:15 AM


Document Has Been Signed on 07/15/2024 10:39 AM - 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: 4DATE:
07/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:42 AM
MET WITH:Lisa Melo (Licensee)TIME COMPLETED:
10:54 AM
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required inspection and met with Licensee, Lisa Melo. Required postings were observed. Annual fees are current.

LPA/Licensee initiated a tour of the facility around 9:00 am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Residents rooms were furnished per regulation. Extra hygiene products and linens were available. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality and stored per regulation. Hot water temperature in bathrooms used by residents measured at 105.2, 105.1 and 106.1 degrees F which are within the range of 105 to 120 degrees F allowed per regulation. Fire extinguisher was last serviced December 18 2023. Smoke detectors and carbon monoxide detector in the hallway was tested and properly working. Last disaster drill conducted on May 29, 2024. Disinfectants and cleaning solutions were stored inaccessible to residents. Administrator Certificate for Lisa Melo, 6022235740, expires on 11/16/2024.

LPA initiated file review at 9:30 am. LPA reviewed four residents files and three staff files. All residents have their medical assessments and care plans updated within the last 12 months. Staff records have current First Aid/CPR certificates. One out of three staff (S1) did not have all additional 20 hours of required training (technical advisory issued). Per Licensee, S1 probably forgot to print the completed certificates to the file, but they were unable to provide them during the visit. Medications and medication records were reviewed.

Licensee will submit updates of the following documents by 7/26/24: Designation of Administrative Responsibility (LIC308) and Personnel Report (LIC500).
-Copy of Liability Insurance (was submitted during visit).

No deficiencies were issued during this visit.
Exit interview was conducted with Licensee and a copy of this report was provided.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2024
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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