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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216803493
Report Date: 05/01/2024
Date Signed: 05/01/2024 12:06:45 PM

Document Has Been Signed on 05/01/2024 12:06 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 LIFE COLLEGEFACILITY NUMBER:
216803493
ADMINISTRATOR/
DIRECTOR:		ABATE, CHASFACILITY TYPE:
775
ADDRESS:837 SWEETSER STREETTELEPHONE:
(415) 897-8676
CITY:NOVATOSTATE: CAZIP CODE:
94945
CAPACITY: 18CENSUS: 9DATE:
05/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Program Director, Jennifer HarterTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
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Licensing Program Analysts (LPA) Helena Rummonds and Jacky Macias arrived unannounced to conduct an Annual Required Inspection at approximately 915AM and was greeted by Program Director, Jennifer Harter. LPAs and Program Director discussed the purpose of the visit. Administrator, Chas Abate arrived shortly after.

LPAs and Program Director initiated a tour of the facility at approximately 9:30AM 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 135 and 138 degrees F which were not within the range of 105-120 degrees F allowed per regulation. Staff immediately turned the temperature down and LPA retested the water temperature and measured to 106.5 degrees F.

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 garden. Facility does not handle medications or client cash resources. Clients were observed engaged in multiple activities throughout the visit. 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. Fire extinguisher was last serviced 05/24/2023. Smoke and Carbon Monoxide alarms were tested and operational during Inspection.

Continued on LIC 809C
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Helena Rummonds
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
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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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: CH&S LIFE COLLEGE
FACILITY NUMBER: 216803493
VISIT DATE: 05/01/2024
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Continued from LIC 809

No deficiencies cited during todays visit.

LPA is requesting the following to be submitted to CCL by June 1, 2024 :
LIC 308 Designation of Facility Responsibility
LIC 500 Personnel Report
LIC 9020 Register of Clients
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Helena Rummonds
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
LIC809 (FAS) - (06/04)
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