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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 126803405
Report Date: 09/20/2023
Date Signed: 09/20/2023 10:35:30 AM

Document Has Been Signed on 09/20/2023 10:35 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:CAROLE SUND CENTERFACILITY NUMBER:
126803405
ADMINISTRATOR:OTT, SUZETTEFACILITY TYPE:
775
ADDRESS:4635 BROADWAYTELEPHONE:
(707) 442-3969
CITY:EUREKASTATE: CAZIP CODE:
95503
CAPACITY: 30CENSUS: 13DATE:
09/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Michelle RussoTIME COMPLETED:
10:45 AM
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At approximately 8:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived unannounced at this Licensed Day Program to conduct an Annual Required Inspection. LPA met with Michelle Russo and toured the facility. This Day Program operates 7 days a week. There were 13 Clients and 6 Staff present at the time of this inspection. The facility consists of offices, a large activity room, large outdoor areas containing a garden, chickens and goats. LPA observed the facility was a comfortable temperature and found all exits and walkways to be unobstructed. The facility grounds were kept clean and without hazards. Clients attend the garden and animals as part of the program.
Toxins are centrally stored and not accessible. Water temperature measured within regulation between 105 and 120 degrees F. at faucets accessible to clients. Client money is not handled by facility. Day Program staff do not handle client medication.

At approximately 9:00AM, LPA reviewed 5 client files and found files to be thorough and contain current client care assessments and individualized Service Plans. Staff records were also found to be current, including staff first aid and CPR training verification. Disaster/fire 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: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2023
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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