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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801810
Report Date: 08/20/2021
Date Signed: 08/20/2021 02:39:24 PM

Document Has Been Signed on 08/20/2021 02:39 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:SENECA HOUSEFACILITY NUMBER:
496801810
ADMINISTRATOR:KAMAU, JOYCE M.FACILITY TYPE:
735
ADDRESS:2821 SENECA LANETELEPHONE:
(707) 579-5751
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY: 6CENSUS: 4DATE:
08/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Joyce Kamau-AdminisrtratorTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Dina Alviso , arrived to conduct an 1 Yr Required inspection and met with Licensee/Administrator Joyce Kamau. The inspection is focused on the Infection Control procedures and practices of this facility.

The LPA was screened by the Administrator upon entry. LPA's temperature was taken and covid screening questions were asked. Administrator logged all the information.

Mitigation plan was reviewed during the inspection, Administrator will revise as discussed, and resubmit to the LPA by 8/24/21. Administrator's RCFE certificate is active-expires 5/23/2023.

There were four (4) residents in care at the facility during this inspection. All visitors, essential visitors, and staff are screened upon entry; Temperatures are taken, and screening questions are to be answered before being allowed to remain in the facility, all information is logged. Clients are screened daily, and observed for any changes throughout the day while in care, all information is logged.

Facility was found to be clean, orderly, and at a comfortable temperature with exits free from obstruction. Food supply was sufficient. Fire extinguishers were serviced and tagged. Toxins are stored in locked cabinets. There was a sufficient supply of hygiene products, cleaners, and paper products for use as needed. Medications are stored and locked making them inaccessible to clients in care. All postings were up and visible to all as required. Facility has a sufficient supply of personal protective equipment(PPE). Administrator had a mask on during the LPA's inspection. Clients were observed with masks on when leaving their rooms and going into common areas.

No deficiencies found in the areas inspected.
Exit interview conducted with the Administrator.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2021
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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