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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 121373926
Report Date: 05/03/2023
Date Signed: 05/03/2023 12:00:44 PM

Document Has Been Signed on 05/03/2023 12:00 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:COMMUNITY CORNERSTONE, INCFACILITY NUMBER:
121373926
ADMINISTRATOR:MANDON, BARBARAFACILITY TYPE:
775
ADDRESS:21 RUSK LANETELEPHONE:
(707) 923-9248
CITY:REDWAYSTATE: CAZIP CODE:
95560
CAPACITY: 30CENSUS: 12DATE:
05/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Barbara MandonTIME COMPLETED:
12:15 PM
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At approximately 9:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived unannounced at this Licensed Day Program to conduct an Annual Required Inspection. LPA met with Barbara Mandon and toured the facility. This Day Program operates Monday -Friday. There were 12 Clients and 6 Staff present at the time of this inspection. The facility consists of offices, activity rooms, a kitchen, and three bathrooms. LPA observed the facility was at a comfortable temperature and found all exits and walkways to be unobstructed. The facility grounds were also kept clean and without hazards. Clients bring lunches but there is also lunch available for clients. Snacks are available for clients.
Toxins are centrally stored and not accessible. Water temperature measured within regulation between 105 and 120 degrees at faucets accessible to clients. Client money is not handled by facility. Medication is secured in a locked cabinet. Clients do crafts and recycling tasks which enables clients a chance to interact with community and make some money. The paper shredding area was clean and orderly. Clients receive training prior to working. At approximately 10:45AM, LPA reviewed 5 of 12 client files and found files to be thorough and contain current client care assessments and individualized Service Plans. Staff first aid and CPR training were current. Disaster drills are conducted monthly with the last drill logged on 4/27/2023.

No deficiencies were found in the areas inspected, No citations issued during today’s visit.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2023
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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