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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216803493
Report Date: 05/26/2026
Date Signed: 05/26/2026 03:52:50 PM

Document Has Been Signed on 05/26/2026 03:52 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: 5DATE:
05/26/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Program Manager, Jennifer HarterTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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At approximately 2:10PM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Required 1 Year visit and met with Program Director, Jennifer Harter. Facility is an Adult Day Program for adults with disabilities and has an approved fire clearance and capacity for 18 Ambulatory clients. Upon arrival, LPA was informed that there were 5 clients attending program and 4 staff members on-site.

At approximately 2:30PM, LPA reviewed the Facility's Staff Roster and found that 1 of 4 staff members was not associated to the facility as required. LPA conducted a walk through of the facility with Program Director. LPA observed the following: Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility has an Infection Control Plan on file. Facility consists of a conference room, a classroom, 2 bathrooms, a kitchen, living room, an office space, and common areas. Clients manage their own monetary funds, medications, transportation, and bring their own snacks and lunches to program.
Hot water temperatures for all sinks in facility were found to be out of compliance with Title 22 regulations, measuring at 104.3F, 104.0F, and 102.0F. During walkthrough, LPA observed the following: Homemade food items in the facility fridge and freezer that were unlabelled, expired foods in the facility cabinet, and two cans of paint located in the facility's second bathroom. Program Director disposed of expired items during visit. LPA discussed with Program Director about labelling food containers in the facility fridge and freezer with the open date and going through the cabinets for expired items.

LPA unable to complete Annual Inspection. Annual Continuation Visit to be conducted at a later date.
Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Exit interview conducted. Copy of report, Plan of Corrections, Appeal Rights discussed and provided to Program Director. Signature on form confirms receipt of documents.

NAME OF LICENSING PROGRAM MANAGER: Victoria Bertozzi
NAME OF LICENSING PROGRAM ANALYST: Caitlynn Felias
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 05/26/2026 03:52 PM - It Cannot Be Edited


Created By: Caitlynn Felias On 05/26/2026 at 03:31 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: CH&S LIFE COLLEGE
FACILITY NUMBER: 216803493

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations made, Licensee did not comply with the section cited above. Facility sinks measured at 104.3F, 104.0F and 102.0F. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/10/2026
Plan of Correction
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Licensee to submit a water temperature log for 10 days for all sinks in facility. Temperature to be checked twice a day starting 05/27/2026 and ending 06/09/2026. Log to include time when water was checked and location of sink. Log to be submitted to CCL for review and approval by POC due date of 06/10/2026.
Type B
Section Cited
CCR
82019(e)
Criminal Record Clearance
(e) Prior to working, residing or volunteering in a licensed day program, all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall do the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, Licensee did not comply with the section cited above. Licensee did not ensure that 1 of 4 staff members was associated to the facility as required. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/29/2026
Plan of Correction
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Licensee to submit Tranfer Request paperwork to have Staff Member 1 (S1) associated to facility. Transfer paperwork to be submitted to CCL by POC due date of 05/29/2026 for processing.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Victoria Bertozzi
NAME OF LICENSING PROGRAM MANAGER:
Caitlynn Felias
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2026


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 05/26/2026 03:52 PM - It Cannot Be Edited


Created By: Caitlynn Felias On 05/26/2026 at 03:31 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: CH&S LIFE COLLEGE
FACILITY NUMBER: 216803493

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82076(a)(1)
Food Service
(a) In day programs providing meals to clients, the following shall apply: (1) All food shall be selected, stored, prepared and served in a safe and healthful manner. All meals shall be of the quality and in the quantity necessary to meet the needs of the clients, and the requirements recommended by the U.S. Department of Agriculture, as specified in Title 7, Code of Federal Regulations, Section 226.20(c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations made, Licensee did not comply with the section cited above. Licensee did not ensure that expired foods were disposed of timely and did not ensure that homemade foods were labelled and dated appropriately. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/05/2026
Plan of Correction
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Licensee to conduct an In-Service training reviewing Food Labelling and Expiration dates. Training to include Topic, Date, Staff Names, Staff Roles, and Staff Signatures. Proof of In-service to be submitted to CCL by POC due date of 06/05/2026.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Victoria Bertozzi
NAME OF LICENSING PROGRAM MANAGER:
Caitlynn Felias
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2026


LIC809 (FAS) - (06/04)
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