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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490108151
Report Date: 05/02/2024
Date Signed: 05/02/2024 02:44:14 PM

Document Has Been Signed on 05/02/2024 02:44 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:GEISNER HOMEFACILITY NUMBER:
490108151
ADMINISTRATOR/
DIRECTOR:
GEISNER, JOSEPHFACILITY TYPE:
735
ADDRESS:2400 DIXIE PLACETELEPHONE:
(707) 573-9579
CITY:SANTA ROSASTATE: CAZIP CODE:
95407
CAPACITY: 6CENSUS: 4DATE:
05/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Lindsay Mullins (staff) TIME VISIT/
INSPECTION COMPLETED:
02:59 PM
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required Inspection and was greeted by staff Lindsay Mullins. Licensee Joseph Geisner was not able to come to the facility, but was available by phone and gave authorization for staff to sign the report. LPA's laptop battery was overheated and LPA had to wait until battery was charged enough to start it.

LPA/Staff toured the facility and observed the following: Facility was a comfortable temperature and passageways were free from obstructions. Client rooms were furnished per regulation. Water temperature in client's bathroom measured at 108.3 degrees F which are within allowable range of 105 to 120 degrees F. Extra hygiene products and linens were available. Cabinets containing cleaning supplies and other items that could pose a risk were locked under the kitchen sink. Facility has at least two days of perishable and one week of non-perishable foods. Medications were centrally stored and locked. Facility doesn't handle Cash for clients. Fire extinguisher was last inspected March 8, 2024. Smoke detectors located throughout the facility were tested and operational. Two Carbon monoxide detector was present in the living room. Fire/Disaster drill was conducted on 3/8/2024. Required posters were observed. Evacuation chair was observed.

File review was initiated by LPA at 1:30pm. Three staff files and four client files were reviewed. Staff have required First Aid and CPR certificates. Training hours complete. Joe Geisner Administrator Certificate 6016659735 expires on 5/11/2024. Medications and medication records were reviewed.

Licensee agreed to submit updates of the following documents by 5/10/2024: Designation of Administrative Responsibility (LIC308) and Personnel Report (LIC500).
No deficiencies were cited during this inspection. Exit interview was conducted with staff and copy of report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2024
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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