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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577003279
Report Date: 04/12/2024
Date Signed: 04/24/2024 12:47:29 PM

Document Has Been Signed on 04/24/2024 12:47 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 HOME IIFACILITY NUMBER:
577003279
ADMINISTRATOR/
DIRECTOR:
PATRICIA BLASFACILITY TYPE:
735
ADDRESS:1130 MEADOW ROADTELEPHONE:
(916) 372-8752
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY: 6CENSUS: 5DATE:
04/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Patricia Blas, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Jill Nakagawa conducted an unannounced Annual Required – 1 yr. Inspection to this facility and met with Administrator Patty Blas. There were no residents present at the time of inspection. 5 out of the 5 residents were at Day Program.

LPA arrived at the facility at approximately 1:20 PM. Patty Blas, Administrator was offsite but returned to facility shortly. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Clients' bedrooms, common areas, kitchen & food storage areas were inspected The kitchen had been renovated during the past year and provides ample space and safe storage for food and supplies.. Kitchen area was locked due to clients having Prader-Willi Syndrome. Three (3) Fire Extinguishers were found to be serviced on 03/19/2024 and fully charged at the time of the visit. Eight (8) smoke detectors and one (1) carbon monoxide detector were found to be operational during the visit. Fire Department inspected facility and found smoke detectors operational. Detectors are checked monthly. Fire Drills are held monthly, the last one conducted on 4/3/2024. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator was 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 clients' bedrooms have lighting & appropriate furnishings and decorated with the input of the clients and their likes and interests.

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SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
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 II
FACILITY NUMBER: 577003279
VISIT DATE: 04/12/2024
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Continued from 809.....

File Review: LPA Nakagawa did a review of personnel and client files and found all to be complete. Patty Blas's Administrator Certificate is in good standing and valid through 02/07/2025.

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: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024
LIC809 (FAS) - (06/04)
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