Facility Evaluation Report

Cap-antioch, Antioch03/01/2023Licence 079201023

Capacity50
Census17
Date signed03/01/2023 11:09:03 AM
The inspector’s account

On 3/1/2022 at 9:50AM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct an Infection Control Inspection. LPA met with Dawn Robinson, Program Director, and explained the purpose of the visit.

Upon entry, LPA's temperature was checked. LPA observed screening station that contained hand sanitizer and sign-in log. LPA toured facility including but not limited to common areas, bathrooms, kitchen and back sitting area. All hand washing stations were equipped with soap, and paper towel, and hand washing poster. Fire extinguishers last serviced 10/25/2022. LPA was not able to measure hot water temperature in the shared clients’ bathroom measured at 111.5 degrees F.

During record review, LPA observed facility has a copy of the Infection Ctonrol Plan on file. LPA observed PPE and paper supplies are sufficient.

The following forms are to be updated and submitted to CCLD by 3/8/2023 :

Updated documents to change Administrator/Program Director

Exit interview conduct and a copy of this report provided.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction