<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216803493
Report Date: 01/21/2025
Date Signed: 02/19/2025 09:47:35 AM

Document Has Been Signed on 02/19/2025 09:47 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
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: 15DATE:
01/21/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Program Manager, Jennifer HarterTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
At approximately 09:15am, Licensing Program Analyst (LPA) Loera arrived unannounced to conduct a Case Management - Incident Visit and met with Program Manager, Jennifer Harter. The purpose of the visit was to follow up and confirm facilities plan for Client 1 (C1) and Client 2 (C2) from an incident that occurred on 12/27/2024 and was submitted to Community Care Licensing (CCL).

Incident Report states, On 12/26/2024 while passing C2 in the parking lot behind Life College, C1 was observed wrapping their arms around C2 from behind. C1s left arm was seen moving about C2s stomach and then moving up to grope C2s left breast. The episode lasted approximately 7 seconds and was witnessed by Staff 1 (S1). S1 instructed C1 to keep their hands to themselves. C1 has struggled with impulsivity issues of this nature, and while they have been largely successful in demonstrating self-control for quite some time now, this was definitely a relapse.

Program Manager confirmed they have a meeting with C1 and their responsible party. As of now the date is unknown. The meeting is to go over the incident and have a new plan in place to ensure this incident doesn't happen again and for the safety of other clients. Facility has a training scheduled on Thursday (unknown date, some time within the next two weeks) that will address C1's behavior and all staff will trained with new plan in place.

LPA has confirmed the following:
  • Adult Day Program (ADP) has a list of goals they go over with C1 daily, copy on file.
  • confirmed that per interviews the steps staff take to ensure C1 is not violating others personal rights is addressed in their IPP, copy on file.
  • ADP has addressed via a plan how to ensure victim C2 is safe at ADP, copy on file.
  • all staff are trained on plans.
  • verified the staffing requirement, is 1:3 staffing during ADP hours.
*****REPORT AMENDED*****

The LIC809 is being amended as staffing ratio was incorrect

No Deficiencies Cited during visit.



Exit interview conducted. Copy of report and LIC811 (Confidential Names) discussed and provided to Program Manager.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Anthony Loera
LICENSING EVALUATOR SIGNATURE: DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1