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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210104528
Report Date: 02/18/2025
Date Signed: 02/18/2025 02:46:03 PM

Document Has Been Signed on 02/18/2025 02:46 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 COLLABORATIVEFACILITY NUMBER:
210104528
ADMINISTRATOR/
DIRECTOR:		SOCKLER, LAURENFACILITY TYPE:
775
ADDRESS:2470 5TH AVENUETELEPHONE:
(415) 453-4240
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY: 110CENSUS: 85DATE:
02/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Lauren Sockler - DirectorTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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At approximately 09:00AM, Licensing Program Analysts (LPAs) Stevenson, Felias and Magdaleno arrived unannounced to conduct a Required 1 Year Inspection visit and met with Director, 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, LPAs were informed that there were currently 85 clients attending Day Program with 18 staff members on-site.
At approximately 09:15 AM, LPAs 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 9:45AM, LPAs 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, garden, sunny and shaded sitting areas, and a music building. Day program activities include art, music, gardening, puzzles, games, care for animals, 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 2025. Facility smoke detectors and carbon monoxide detectors were tested and operational. Facility's last emergency drill was conducted January 2025.

At approximately 10:55AM LPAs reviewed ten (10) client files and six (6) staff 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: Kimberley Mota
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
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: 02/18/2025
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Continued from LIC809

LPAs also followed up on one incident report that was self submitted to Community Care Licensing (CCL).

Incident Report 1: CCL received an incident report on 07/10/2024. Report stated that on 07/10/2024, Client 1 (C1) was administered a medication that was for another client. Facility monitored C1 for adverse effects. Facility made all appropriate notifications per regulation. (deficiency cited, LIC809D and LIC421FC, Regulation 82075(b)).
Per discussion with Director, after the incident, facility updated their medication processes and implemented a color coding system. LPAs observed new medication system in place. Deficiency cited today has been cleared and Plan of Corrections Letter provided during visit.

LPAs 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, 03/18/2025.

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.

**An immediate civil penalty assessment in the total amount of $250.00 has been issued for a repeat violation of Regulation 82075(b) within a 12 month period. (See LIC421FC).**

Exit interview conducted. Copy of report, LIC809D, LIC421FC (civil penalty), LIC 811 (Confidential Names), Plan of Corrections Letter and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/18/2025 02:46 PM - It Cannot Be Edited


Created By: Star Stevenson On 02/18/2025 at 01:41 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: 02/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82075(b)
82075 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
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Based on document review and interview conducted, Licensee did not comply with the section cited above. C1 was administered a medication meant for another client. This poses an immediate health, safety or personal rights risk to clients in care.
POC Due Date: 02/19/2025
Plan of Correction
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Licensee to submit xyz by POC due date of 02/19/2025.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Kimberley Mota
LICENSING EVALUATOR NAME:Star Stevenson
LICENSING EVALUATOR SIGNATURE:
DATE: 02/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/18/2025


LIC809 (FAS) - (06/04)
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