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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216800673
Report Date: 12/16/2022
Date Signed: 12/16/2022 02:34:12 PM

Document Has Been Signed on 12/16/2022 02:34 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
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: 21DATE:
12/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Administrator, Harold WilliamsTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at CH&S Enterprise Day Service for the purpose of Required 1 year inspection. LPA was greeted at the door by Program Manager, Harold Williams, and was granted access into the facility.

LPA toured building and grounds with the Program Manager. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Day activity rooms, kitchen, and bathrooms were observed to be clean and at a comfortable temperature. Smoke detectors and sprinklers system are hard wired – audible and visual alarms. Fire extinguishers are fully charged with last inspection on 11/2022. 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 at 115.3 degrees in 3 out of 3 bathrooms 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. Disaster Drills have been conducted with the last date in August 2022.

In addition, LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Staff have had all PPE training required on file and acquired N-95 fit testing.

LPA requested the following documents to be sent:
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: CH&S ENTERPRISE DAY SERVICE
FACILITY NUMBER: 216800673
VISIT DATE: 12/16/2022
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LIC 500- Personnel Report
LIC 308- Designation of Responsibility
LIC 309- Administrative Organization
LIC 400- Affidavit regarding Client Cash Resources
Updated facility sketch
Updated Emergency Disaster Plan (LIC 610D)
Fire Alarm System testing documentation for 2022
Surety Bond
Most up-to-date Liability insurance
Control of Property
Register of residents

No deficiencies were observed or cited during today's Required 1- Year inspection. Exit interview was conducted and a copy of this report was emailed to the facility Program Manager.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022
LIC809 (FAS) - (06/04)
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