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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801810
Report Date: 07/13/2023
Date Signed: 07/13/2023 04:20:40 PM

Document Has Been Signed on 07/13/2023 04:20 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:
07/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Joyce Kamau- AdministratorTIME COMPLETED:
04:35 PM
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Licensing Program Analyst (LPA) Alviso , arrived to conduct a Required- 1 Year visit , on 7/13/23 at approximately 1:55pm, and met with Licensee/Administrator Joyce Kamau. There are currently four (4) residents in care; All four clients were at day program.

LPA observed an area in the entry of the home used for screening if needed. Facility has a required infection control plan. The facility has an emergency disaster plan as required. Administrator's certificate is active- expires 5/3/2025. Fire clearance is approved for six(6) ambulatory. The four clients all have private rooms. .

LPA toured the facility with the Administrator. LPA observed a large supply of fresh fruits for clients in care; The facility had a sufficient supply of food, perishable and nonperishable. The facility smoke alarms, eight(8), were all working properly during the inspection. The facility's carbon Monoxide detector was working properly during the inspection. Fire extinguishers, two(2), were serviced and tagged as required, expires 9/23/23. Hot water was checked T 111.7 F. which is within regulation of no lower than 105.F and no higher than 120.F. All exits were unobstructed. The home was observed to be at a comfortable temperature. The facility was clean and orderly. The facility had a sufficient supply of hygiene products, cleaners, and paper products. The backyard had outside patio furniture for clients use.

The LPA reviewed four(4) client files. The LPA reviewed two(2) staff files. All staff have criminal record clearance as required. All files were complete.

Continued on LIC809C...
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: SENECA HOUSE
FACILITY NUMBER: 496801810
VISIT DATE: 07/13/2023
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LPA is requesting the following documents be updated and submitted by 8/7/23:
LIC308 - Designation of Administrator Responsibility
LIC500 - Personnel Report
LIC610- Emergency Disaster Plan
LIC400- Affidavit Regarding Client Cash Resources
Copy of Surety Bond
Infection Control Plan- Administrator recently submitted an updated plan.

No deficiencies cited today.
Exit interview conducted with the Administrator.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
LIC809 (FAS) - (06/04)
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