<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 236801775
Report Date: 09/21/2021
Date Signed: 09/21/2021 02:25:35 PM

Document Has Been Signed on 09/21/2021 02:25 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:EQUINOX CARE FACILITY LLCFACILITY NUMBER:
236801775
ADMINISTRATOR:AJEL, AGNESFACILITY TYPE:
740
ADDRESS:38281 S HWY 1TELEPHONE:
(707) 884-4061
CITY:GUALALASTATE: CAZIP CODE:
95445
CAPACITY: 9CENSUS: 8DATE:
09/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Agnes AjelTIME COMPLETED:
02:40 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
At approximately 12:45PM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an Annual Required infection control inspection. This inspection will focus on the Infection Control procedures and practices of this facility. LPA met with Administrator Agnes Ajel. There were 8 residents present at the facility.

LPA arrived at the facility and did not have temperature checked or health questions asked. LPA discussed with Administrator the importance if asking screening questions and taking temperatures before visitors enter the facility. The entrance area has a small table with hand sanitizer, visitor log and items designated for visitors and staff before coming into work or visit. Visitor log showed temperatures are taken on a normal basis for visitors to the facility. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers were found to be charged and inspected within the last 12 months. Toxins are stored and not accessible. There was a supply of cleaners, hygiene products and paper products available for resident use.

Facility has submitted and received approval for a Covid Mitigation plan. Posters are in place at the entrance and throughout the building. Facility has PPE supplies. Medications are secure and not accessible to residents. Facility has a 30-day supply of medication. Residents do not typically wear masks inside the facility but have them available. Residents do however, 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: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1