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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801810
Report Date: 08/04/2022
Date Signed: 08/04/2022 02:33:55 PM

Document Has Been Signed on 08/04/2022 02:33 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: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:
08/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Joyce Kamau-AdministratorTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Alviso , arrived to conduct a Required 1 Year inspection and met with Licensee/Administrator Joyce Kamau. This inspection is focused on the Infection Control procedures and practices of this facility.

The LPA was screened by the Administrator upon entry.Screenings are done for all visitors and staff, temperature is taken and screening questions are asked. All screenings are logged.
Facility has submitted the new Infection Control Plan as required by the Department. Administrator's certificate is active-expires 5/3/2023. Fire clearance is approved for six(6) ambulatory.
There are four (4) residents in care at the facility, one client was away visiting with family. Clients are screened daily, and observed for any changes, all information is logged.

Facility was found to be clean, orderly, and at a comfortable temperature for clients in care, and exits were free from obstruction. Fire extinguishers were serviced and tagged-expires 9/13/2022. Food supply was sufficient. 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.

The facility has new front of the house iron fencing and locking gate; The Administrator is submitting an updated sketch by 8/5/2022 as requested by the LPA. The Administrator will continue to ensure the gate is not locked, until gate is repaired, and it is fire cleared by the local fire department as required. Administrator will submit plan on the gate as discussed.

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: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2022
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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