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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210110627
Report Date: 05/24/2024
Date Signed: 05/24/2024 02:22:01 PM

Document Has Been Signed on 05/24/2024 02:22 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:CEDARS BROWN DRIVEFACILITY NUMBER:
210110627
ADMINISTRATOR/
DIRECTOR:
LEPE, MARIAFACILITY TYPE:
735
ADDRESS:6 BROWN DRIVETELEPHONE:
(415) 892-1421
CITY:NOVATOSTATE: CAZIP CODE:
94947
CAPACITY: 6CENSUS: 4DATE:
05/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Adminstrator, Maria LepeTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Helena Rummonds arrived unannounced at approximately 12:45 PM to conduct an Annual Required inspection and was greeted by Administrator, Maria Lepe. LPA and Administrator discussed the purpose of the visit.

LPA and Administrator initiated a tour of the facility and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Client rooms were furnished per regulation. Water temperature in sinks accessible to clients measured at 113 and 114 degrees F which is within the range of 105 to 120 degrees F allowed per regulation.

Extra hygiene products and linens were available. Closets containing cleaning supplies were locked. Facility has at least two days of perishable and one week of non-perishable foods which were of quality and stored per regulation. Emergency food and water is stored in the garage and is frequently rotated.


Fire extinguishers were last serviced February 13, 2024. Facility has a pull fire alarm that is wired directly to the fire department. Carbon monoxide detector was tested and operational during inspection. Facility conducts a monthly disaster drill which includes testing all smoke and carbon monoxide detectors. Most recent disaster drill was conducted 04/26/2024 and all alarms were in operating condition.

Four client files were reviewed. Client files contained all required documents. LPA could not complete inspection at this time. LPA will return at a later date to complete inspection.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Helena Rummonds
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2024
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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