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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803986
Report Date: 10/23/2024
Date Signed: 10/23/2024 02:45:56 PM

Document Has Been Signed on 10/23/2024 02:45 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:SUMMERFIELD HOME CAREFACILITY NUMBER:
496803986
ADMINISTRATOR/
DIRECTOR:
WAINAINA, KENNEDYFACILITY TYPE:
740
ADDRESS:2725 SUMMERFIELD RD.TELEPHONE:
(707) 537-6669
CITY:SANTA ROSASTATE: CAZIP CODE:
95405
CAPACITY: 6CENSUS: 4DATE:
10/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:07 PM
MET WITH:Kennedy Wainaina, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by Administrator Kennedy Wainaina.

At approximately 1:00pm LPA toured the building and grounds. The facility was found to be exceptionally clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered. Kitchen cabinet containing cleaning supplies was locked. Kitchen drawer with sharp knives locked.

All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were remarkably clean and in good repair. Extra hygiene products and linens were available. Resident bathroom had required bath mat and grab bar. Water temperature in sink accessible to residents in care measured at 107.2 degrees F which is within the allowable range of 105 to 120 degrees F.

Fire extinguishers were last inspected 3/20/2024. Smoke/Carbon Monoxide detectors located throughout the facility are operational. Facility’s last quarterly disaster drills were conducted on 9/1/2024. Facility has a backup generator for use during a power outage.

At approximately 1:30pm LPA conducted review of 4 staff records. All required documentation present. At approximately 1:45pm LPA conducted a review of 4 resident records. All required documentation present. At approximately 2:15pm LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. No deficiencies

Kennedy Wainaina Administrator Certificate 7025718740 expires 6/30/2025. All fees are current.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report and Liability Insurance

No deficiencies cited.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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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