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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216800673
Report Date: 10/08/2021
Date Signed: 10/11/2021 09:42:19 AM

Document Has Been Signed on 10/11/2021 09:42 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:CH&S ENTERPRISE DAY SERVICEFACILITY NUMBER:
216800673
ADMINISTRATOR:ABATE, CHASFACILITY TYPE:
775
ADDRESS:405 NORMAN DRIVETELEPHONE:
(415) 883-4048
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY: 38CENSUS: 22DATE:
10/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Chas Abate - Licensee/AdministratorTIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Fernandes-Goes conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility and was welcome by staff Harold Williams. Licensee/Administrator arrived during the visit. There were 22 clients present at the facility. Facility has different activities been offered through out of the day including outings.

LPA toured the facility on 10/8/2021 with program manager Harold Williams. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. LPA toured building and grounds, day activity rooms, kitchen, and bathrooms. Smoke detectors and sprinklers system are hard wired – audible and visual alarms. Program Director state that hard wired smoke detectors and sprinklers system were last inspected on 2019, however; facility has tested alarms in 6/2021. Fire extinguishers are fully charged with last inspection on 11/2020. Clients have their own transportation. Facility does not transport clients at this time. Toxins, chemicals and hazardous items were safely stored in a locked closet in the hallway. Bathrooms were all equipped with soap dispensers and individual paper towels. There is a sufficient supply of sanitary products on hand. Hot water temperature measured between 116.7 degrees F and 119.2 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in bathrooms. Clients provide their own snacks and lunches but program will supply food for special occasions. There is one large refrigerator available for client food. Facility doesn’t administer medications or handles P&I. Facility has PPE supply stored in the facility hallway closet. Staff have had all PPE training required on file and acquired N-95 fit testing. In addition, LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Disaster Drills have been conducted with the last dated 8/11/21.

No deficiencies observed or cited during today's visit.

Department is requesting the following to be submitted by 10/15/2021: LIC309 Administrative Organization; LIC 308 Designation of Responsibility; copy of job description; LIC 500 Personnel Report; Theft & Loss Policy; and Transportation Procedures.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Carla Fernandes-Goes
LICENSING EVALUATOR SIGNATURE: DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2021
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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