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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804136
Report Date: 08/10/2023
Date Signed: 08/10/2023 02:22:59 PM

Document Has Been Signed on 08/10/2023 02:22 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:HUNTER HOMEFACILITY NUMBER:
496804136
ADMINISTRATOR:ALLI, FUNMILOLA I.FACILITY TYPE:
734
ADDRESS:604 HUNTER LANETELEPHONE:
(909) 908-2766
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY: 4CENSUS: 4DATE:
08/10/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Monica Hernandez, RNTIME COMPLETED:
02:30 PM
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Licensing Program Analyst Bertozzi arrived unannounced to conduct a Post Licensing inspection and met with Monica Hernandez, RN. Administrator, Lola Alli was unable to come to the facility but was available by phone and gave permission for on duty nurse to sign report.

LPA initiated a tour of the facility around 12:20pm and observed the following: Facility was a comfortable temperature and passageways were free from obstructions. There were three clients at home during inspection and one was at day program. Water temperature in clients' bathroom measured at 110 degrees F which is within allowable range of 105 to 120 degrees F. Cabinet containing cleaning supplies and other items that could pose a risk were inaccessible to clients in care. Facility has at least two days of perishable and one week of non-perishable foods. Medications were centrally stored and locked.

Fire extinguishers were serviced February 2023 and are not yet due for servicing. Smoke and Carbon Monoxide detectors were not tested due to sleeping client.

Four client files were reviewed. Staff files and Client P&I were unavailable as the staff in the facility do not have access to them and the Administrator was not available. Medications and medication records were reviewed.

No deficiencies cited during this inspection.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2023
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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