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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577000755
Report Date: 06/23/2022
Date Signed: 06/23/2022 02:07:56 PM

Document Has Been Signed on 06/23/2022 02:07 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:E & J GRIFFIN FAMILY CARE HOMEFACILITY NUMBER:
577000755
ADMINISTRATOR:GABRIELA ECHEVARRIAFACILITY TYPE:
735
ADDRESS:106 CASELLI CTTELEPHONE:
(530) 795-5938
CITY:WINTERSSTATE: CAZIP CODE:
95694
CAPACITY: 6CENSUS: 4DATE:
06/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:June Penny, Program ManagerTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an inspection focusing on the Infection Control Plan and Hydration. LPA was met at the door by Program Manager,June Penny. The facility has one central entry point and staff, residents and visitors are screened before entry and results are logged.
Program Manager gave LPA a tour of the facility, which was clean and a comfortable temperature of 74F. The kitchen had a supply of food as required in Title 22. There were plenty of drinks on hand, to make sure all residents are getting the necessary fluids for adequate hydration.
All 4 residents are participating in day programs. The facility has had no cases of Covid-19.
Program Manager mentioned that staff are taking part in training programs to initiate the Infection Control Plan.

There were no deficiencies at the time of inspection.
No citations issued.

Exit interview conducted with Program Manager. Copy of this report left with facility.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
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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