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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577000755
Report Date: 11/02/2022
Date Signed: 11/02/2022 02:59:34 PM

Document Has Been Signed on 11/02/2022 02:59 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:
11/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:June Penny, House ManagerTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced at E & J Griffin Family Care Home on November 2, 2022 at approximately 1:30 PM to conduct an annual inspection focusing on Covid-19 Infection Control practices.

LPA was met at the door by June Penny, House Manager. LPA was screened before entry into the facility. All visitors, essential visitors, and staff are screened upon entry; temperatures are taken, information is logged. Residents are screened and observed for any changes three(3) times a day, especially when participating in program; all information is logged. House Manager tests for Covid-19 as situations arise. Facility was found to be clean, orderly, and at a comfortable temperature of 73F with all exits free from obstruction. Toxins are stored in locked cabinets. Facility has a small med room with well organized records and medications, which is locked making them inaccessible to residents and staff that do not handle medications. There was a sufficient supply of hygiene products, cleaners, and paper products for use as needed.

There are four (4) residents at the facility; three of the four are diagnosed with Prader-Willi Syndrome so access to the kitchen is limited to staff, but snacks and meals are served on a predictable schedule for the residents.
All four (4) residents participate in "Program".

No deficiencies during today's inspection.
No citations issued.
Exit interview conducted with the House Manager.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2022
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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