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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216800673
Report Date: 11/27/2023
Date Signed: 11/27/2023 12:14:33 PM

Document Has Been Signed on 11/27/2023 12:14 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: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: 31DATE:
11/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Program Director, Harold WilliamsTIME COMPLETED:
12:25 PM
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Licensing Program Analyst (LPA) Helena Rummonds arrived unannounced to conduct an Annual Required Inspection at approximately 9AM and was greeted by Program Director, Harold Williams. LPA and Program Director discussed the purpose of the visit.

LPA and Program Director initiated a tour of the facility at approximately 9:10AM and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Water temperature in sinks accessible to clients measured at 116, 119, 119 and 120 degrees F which are within the range of 105-120 degrees F allowed per regulation. Extra Personal Protective Equipment is available. Cleaning supplies were located in hallway closet and locked. Facility has a large outdoor area free from hazards with a shaded area and a client vegetable garden. Facility does not handle medications or client cash resources. Clients were observed engaged in multiple activities throughout the visit, and has extra puzzles, games, art supplies, and various other activities available for client use. Facility has a kitchen to provide snacks and occasional lunches to clients, although clients usually bring their own lunches.

5 staff files and 5 client files were reviewed. Staff have required first aid. Clients have updated IPP/ISP (Individual Program Plan/ Individual Service Plan) on file and up to date. Facility is conducting disaster drills per regulation and conducting staff trainings on a monthly basis. Fire extinguishers were last serviced 11/02/2023. Fire alarms are hardwired and were last tested and operational during fire inspection on 11/02/2023. Carbon Monoxide detector is located in kitchen and was last tested and operational on 11/02/2023.

No deficiencies cited during todays visit.

LPA is requesting the following to be submitted to CCL by 12/27/2023:
LIC 500 (Personnel Report)
Emergency Disaster Plan (If any changes)
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Helena Rummonds
LICENSING EVALUATOR SIGNATURE: DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/27/2023
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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