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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210104528
Report Date: 12/22/2022
Date Signed: 12/22/2022 11:30:17 AM

Document Has Been Signed on 12/22/2022 11:30 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:TEXTILE ARTS COLLABORATIVEFACILITY NUMBER:
210104528
ADMINISTRATOR:SOCKLER, LAURENFACILITY TYPE:
775
ADDRESS:2470 5TH AVENUETELEPHONE:
(415) 453-4240
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY: 110CENSUS: 94DATE:
12/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Administrator, Lauren SocklerTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Erik Gonzalez Campos arrived unannounced on 12/22/2022 to conduct a required - 1 year inspection. This inspection is focused on the infection control procedures and practices of this facility. LPA met with administrator, Lauren Sockler.

LPA observed COVID postings and screening materials at the front entrance. LPA toured building and grounds which were clean and in good repair. Exits and walkways were free from obstructions. Facility is spread out across three buildings which allows ample room for social distancing. Main building includes admin offices and activity space for clients. Next to the building is a portable bungalow for special projects. Kitchen has been remodeled and is fully operational. LPA observed coffee and tea served for clients as well as a delivery of fresh perishable and non-perishable foods. Toxins are kept locked and secured. Fire extinguishers inspected were charged and current. Facility disinfects daily. Screening procedures are conducted for staff, visitors, and clients. Facility has a sufficient supply of Personal Protective Equipment available.

LPA and administrator discussed vaccination exceptions. LPA will follow up with relevant PINS.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this inspection:

LIC500- Personnel Report
LIC308- Designation of Responsibility
LIC610D- Disaster Plan

Exit interview conducted with administrator and a copy of this report emailed to the facility.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Erik Gonzalez Campos
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2022
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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