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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 121373153
Report Date: 05/20/2021
Date Signed: 05/20/2021 10:43:22 AM

Document Has Been Signed on 05/20/2021 10:43 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:AGUILAR MANORFACILITY NUMBER:
121373153
ADMINISTRATOR:AGUILAR, STIIVIFACILITY TYPE:
740
ADDRESS:6433 EGGERT ROADTELEPHONE:
(707) 443-5160
CITY:EUREKASTATE: CAZIP CODE:
95501
CAPACITY: 15CENSUS: 11DATE:
05/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Stiivi AguilarTIME COMPLETED:
11:00 AM
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At approximately 09:00 AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility, unannounced, to conduct an Annual Required inspection. This inspection will focus on the Infection Control procedures and practices of this facility. LPA met with Licensee Stiivi Aguilar. There were 11 Clients present at the facility.

LPA arrived at the facility and had temperature checked and health questions asked. 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. Fire Extinguishers were found to be charged and inspected within the last 12 months. Smoke Detectors & Carbon monoxide detector was found to be operational during the visit. Food stores of perishable and nonperishable foods were within regulation. Food in the kitchen refrigerator was properly stored. Toxins are stored and not accessible. There was a supply of cleaners, hygiene products and paper products available for client use.

Facility has submitted and received approval for a Covid Mitigation plan. Posters are in place at the entrance and throughout the building. The entrance area has a small table with hand sanitizer, thermometer and other items designated for visitors and staff before coming into work. Facility has PPE supplies. Medications are secure and not accessible to clients. Facility has a 30-day supply of medication for clients. Clients do not typically wear masks inside the facility but have them available and they wear masks while away from the facility. All staff had masks on during this visit.

There were no deficiencies found in the areas inspected.



No citations issued.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 05/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2021
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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