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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 236804090
Report Date: 08/24/2023
Date Signed: 08/24/2023 11:01:52 AM

Document Has Been Signed on 08/24/2023 11:01 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:OCEANFRONT CARE HOME LLCFACILITY NUMBER:
236804090
ADMINISTRATOR:GYURICS, TUNDEFACILITY TYPE:
740
ADDRESS:1370 NAVARRO BLUFF ROADTELEPHONE:
(707) 877-1698
CITY:ALBIONSTATE: CAZIP CODE:
95410
CAPACITY: 6CENSUS: 3DATE:
08/24/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Sedra WilsonTIME COMPLETED:
11:15 AM
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At approximately 8:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct a Post Licensing inspection. LPA met with care giver Sedra Wilson. At approximately 8:15AM, LPA toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible areas. LPA observed activity supplies for resident use. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerator and freezer were clean, and food was stored properly. Toxins are stored in a locked closet. Water temperature measured within regulation between 105 and 120 degrees F at faucets accessible to residents. Fire extinguishers inspected were charged. Smoke detectors were in working order. Carbon Monoxide detector was present. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure. LPA observed a locked medication box in a refrigerator with expired medication. Staff will ensure the medication is destroyed per their procedure.
At approximately 9:00AM, LPA reviewed 3 of 3 resident records and found residents to have physician's reports, signed admission agreements, care plans and physician's orders on file. At approximately 10:00AM, LPA reviewed 2 of 2 on duty staff records which contained documentation of current first aid, CPR training, and completed training records as required. LPA interviewed 2 staff during this inspection.
Facility has a generator to supply power during an outage. Facility has supplies enough to operate for more than 72 hours in an emergency.

No citations issued during this visit.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2023
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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