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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804136
Report Date: 01/04/2024
Date Signed: 01/04/2024 01:11:40 PM

Document Has Been Signed on 01/04/2024 01:11 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: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:
01/04/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Monica Hernandez-RNTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Alviso conducted a case management inspection, on 1/4/2024 at approximately 9:45am, and met with RN Monica Hernandez. LPA observed two additional staff/caregivers, Edith & Elvira, on duty during the inspection. There are four (4) clients that reside in the home; All four (4) clients were at day program.

This inspection is to follow-up on a report received from CDDS of the Semi Annual visit that was recently completed at the facility. LPA reviewed the report findings and concerns with the facility Administrator Lola Alli, and Lead RN Monica Hernandez.

LPA toured the facility with the Administrator Alli, and RN Hernandez. The LPA observed all areas of concern, inside and outside the facility, from the DDS semi annual report. LPA found all items have been addressed by the Administrator.
The LPA discussed the following regulations regarding the concerns reviewed on the DDS semi-annual report: Buildings & Grounds 80087, Health Related Services 80075, Food Service 80076, and Safeguard of Client Cash Resources 80026. The facility has at least one licensed nurse on each shift, and the facility has infection control requirements as part of their plan of operation; The LPA did discuss infection control requirements/information from regulations.

The Administrator Alli and RN Hernandez stated their understanding of all items and regulations reviewed with them.

The facility has obtained permits to build a large storage/garage, which includes, an entry door and two (2) automatic garage doors. This storage/ garage is almost complete. The Administrator will submit an updated facility sketch, of the outside grounds, to the licensing office as required. Once Administrator notifies the LPA that the storage/garage is complete, the Department will request a fire clearance inspection be completed.

There were no deficiencies cited during today's inspection.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2024
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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