125001082-5-3-2023-21-AS-CARD-CRGTQJ-20230503145600

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 125001082
Report Date: 05/03/2023
Date Signed: 05/03/2023 02:56:04 PM

Document Has Been Signed on 05/03/2023 02:56 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:	DIANE CATHEY CENTER		FACILITY NUMBER:	125001082
ADMINISTRATOR:	BARBARA NELSON		FACILITY TYPE:	775
ADDRESS:	2800 SCHOOL STREET		TELEPHONE:	(707) 725-5860
CITY:	FORTUNA	STATE: CA	ZIP CODE:	95540
CAPACITY: 13		CENSUS: 12	DATE:	05/03/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Ashley Nichols		TIME COMPLETED:	03:10 PM

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At approximately 1:00PM, Licensing Program Analyst (LPA) Chris Arnhold arrived unannounced at this Licensed Day Program to conduct an Annual Required Inspection. LPA met with Ashley Nichols and toured the facility. This Day Program operates Monday -Friday. There were 12 Clients and 8 Staff present at the time of this inspection. The facility consists of offices, activity rooms, a kitchen, and two bathrooms. LPA observed the facility was 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 or can receive assistance in making the lunch each day. Snacks are available for clients.
Toxins are not accessible. Water temperature measured within regulation between 105 and 120 degrees at faucets accessible to clients. Client money is not handled by facility. Day Program staff do not currently dispense medications. 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 1:35PM, 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 was current. Disaster drills are conducted monthly.

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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