210104528-2-27-2024-21-AS-CFES-D2UTDH-20240227133822

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 210104528
Report Date: 02/27/2024
Date Signed: 02/27/2024 01:38:30 PM

Document Has Been Signed on 02/27/2024 01:38 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME:	TEXTILE ARTS COLLABORATIVE		FACILITY NUMBER:	210104528
ADMINISTRATOR:	SOCKLER, LAUREN		FACILITY TYPE:	775
ADDRESS:	2470 5TH AVENUE		TELEPHONE:	(415) 453-4240
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94901
CAPACITY: 110		CENSUS: 70	DATE:	02/27/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Assistant Director, Denise Colwell, and Administrator, Lauren Sockler		TIME COMPLETED:	01:50 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	At approximately 10:00AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Required 1 Year Inspection visit and met with Assistant Director, Denise Colwell, and Administrator, Lauren Sockler. The facility is an Adult Day Program for Adults with Disabilities, and has an approved fire clearance for 90 ambulatory and 20 non ambulatory clients for a total capacity of 110 clients. Upon arrival, LPA was informed that there were currently 70 clients attending Day Program with 20 staff members on-site. At approximately 10:15AM, LPA reviewed the Facility's Staff Roster with Administrator and found that all staff members on site were background cleared and associated to the facility per regulation. At approximately 10:40AM, LPA conducted a walk through of the facility with Administrator and observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility has multiple buildings - The Ranch Building, TAC Building, which includes the facility's Senior Program, the Barn Art Studio, and the Music Building. Day program activities include art, care for animals, gardening, honey bee keeping, fabric textile loomed cloth production, community grounds keeping and other organized activities depending on the season. Clients are able to sell their art and products at local Farmer's Markets, local merchants and the Cedars Art Studio. Clients are provided lunch and snacks which are prepared on-site and some clients bring their own lunches. Toxins were observed to be stored inaccessible to clients. Hot water temperatures for a sample size of 5 sinks were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility's fire extinguishers were last inspected January 2024. Facility smoke detectors and carbon monoxide detectors were tested and operational. Facility's last emergency drill was conducted February 2024. LPA reviewed staff files, client files, and client medications. All files were all found to be well organized, thorough, and contained the required documentation. Staff files had current First Aid and CPR certification. Medication was observed to be centrally stored and secure. Facility does not manage P&I monies for clients. Continued on LIC809C

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: TEXTILE ARTS COLLABORATIVE	FACILITY NUMBER: 210104528
	VISIT DATE: 02/27/2024

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Continued from LIC809

LPA also followed up on two incident reports that was self submitted to Community Care Licensing (CCL).

Incident Report 1: CCL received an incident report on 07/12/2023. Report stated that on 07/12/2023, a medication was administered to Client 1 that was for another client. Facility monitored C1 for adverse effects. Facility made all appropriate notifications per regulation. (This deficiency has been cited, see LIC809D, Regulation 82075(b)).

Incident Report 2: CCL received an incident report on 07/21/2023. Report stated that on 07/20/2023, Client 2 (C2) did not receive their noon medications. Facility monitored C2 for adverse effects. Facility made all appropriate notifications per regulation.

Facility conducted a in-service training covering Medication Management on 08/01/2023. LPA was provided with a copy of training documentation and cleared the deficiency cited today, 02/27/2024, during visit.

LPA requested the following documents to update facility file:

Designation of Facility Responsibility (LIC 308)
Emergency Disaster Plan (LIC 610D)
Updated Personnel Report (LIC 500)

Documents to be submitted to CCL by due date of Wednesday, 03/27/2024.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiencies, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Exit interview conducted. Plan of Corrections reviewed and developed with Administrator. Copy of report, LIC809D, LIC 811 (Confidential Names), Plan of Corrections, Appeal Rights, and Plan of Corrections Letter discussed and provided to Administrator. Signature on form confirms receipt of documents.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/27/2024 01:38 PM - It Cannot Be Edited

Created By: Caitlynn Felias On 02/27/2024 at 01:22 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: TEXTILE ARTS COLLABORATIVE	FACILITY NUMBER: 210104528
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

82075(b)

Health-Related Services

(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on document review, Licensee did not comply with the section cited above. C1 was administered a medication meant for another client, and C2 missed their medications. This poses an immediate health, safety or personal rights risk to clients in care.
	POC Due Date: 02/28/2024
	Plan of Correction
1 2 3 4	Licensee conducted In-Service Training on Medication Management for all staff who administer medications on 08/01/2023. Deficiency cleared during visit.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Victoria Bertozzi

LICENSING EVALUATOR NAME:

Caitlynn Felias

LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

LIC809 (FAS) - (06/04)

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