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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577003279
Report Date: 02/15/2022
Date Signed: 02/15/2022 10:38:26 AM

Document Has Been Signed on 02/15/2022 10:38 AM - 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 HOME IIFACILITY NUMBER:
577003279
ADMINISTRATOR:PATRICIA BLASFACILITY TYPE:
735
ADDRESS:1130 MEADOW ROADTELEPHONE:
(916) 372-8752
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY: 6CENSUS: 5DATE:
02/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Patty Blas, AdministratorTIME COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Jill Nakagawa conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility and met with Administrator Patty Blas. Clients were not present at the facility due to participation in their day programs.

LPA arrived at the facility at approximately 9:10 AM and was screened at the door; information and screening questions are kept in a log. Staff and residents are also screened each day and kept in separate logs. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Client’s bedrooms, common areas, kitchen & food storage areas were inspected. Kitchen area was locked due to clients all having PW. Fire Extinguisher was found to be serviced on 03/10/21 and was fully charged at the time of the visit. 5 Smoke Detectors & Carbon monoxide detector was found to be operational during the visit. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored in a locked cabinet inside the garage. Dangerous items were stored inaccessible to clients. There was a supply of cleaners, hygiene products and paper products available for clients. All client’s bedrooms have lighting & appropriate furnishings.

Infection Control:
Facility has submitted a mitigation program plan that was approved. Posters have been placed at entrance. A small table with hand sanitizer and other items designated for visitors will be placed at entrance/office table. There have been no visitors at facility at this time, but a visitation area has been set up in the back yard.

There were no deficiencies. No citations issued at this inspection.

Exit interview conducted with Administrator, Patty Blas.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2022
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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