216803659-5-26-2026-21-AS-CFES-DUFS7F-20260526133728

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 216803659
Report Date: 05/26/2026
Date Signed: 05/26/2026 01:37:48 PM

Document Has Been Signed on 05/26/2026 01:37 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:	AUTISTRY STUDIOS		FACILITY NUMBER:	216803659
ADMINISTRATOR/ DIRECTOR:	LAWSON, JANET K		FACILITY TYPE:	775
ADDRESS:	448 DU BOIS ST		TELEPHONE:	(415) 454-1037
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94901
CAPACITY: 30		CENSUS: 4	DATE:	05/26/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:20 AM
MET WITH:	Chief Operating Officer (COO), Daniel Swearingen and Office Manager (OM), Rhoda Robertson		TIME VISIT/ INSPECTION COMPLETED:	01:45 PM

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 9:20AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Required 1 Year visit and met with Chief Operating Officer (COO), Daniel Swearingen and Office Manager (OM), Rhoda Robertson. Facility is an Adult Day Program for high functioning clients/students, and has an approved fire clearance for 30 Ambulatory clients. Upon arrival, LPA was informed that there were 4 clients attending program and and 7 staff members on-site. LPA was informed that all clients at program for the day were out of the community on a group walk. At approximately 9:35AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 9:40AM, LPA conducted a walk through of the facility with the OM. 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 has three activity rooms, a kitchen, a large work shop, a supply room for toxins and art supplies, and office spaces. Clients have access to the three activity rooms. Clients do not enter the work shop, kitchen, or supply room without staff supervision. Clients do not enter staff office spaces. 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 within Title 22 regulations of 105 to 120 degrees Fahrenheit. During walkthrough, LPA observed that some food containers were not labelled with the open date in the facility kitchen area. LPA discussed with OM and COO about labelling food containers in the facility fridge with the open date. LPA reviewed staff and client files. Staff files were all found to have current First Aid and CPR certification. LPA discussed with OM on ensuring that there is documented proof of training for all facility staff upon hire and annually. Per OM, they conduct a lot of hands on training/shadowing for their facility staff. 1 of 5 client files were found to have a incomplete medical assessment. 2 of 5 client files were observed to have Admissions Agreements signed by the client but were missing signatures from the Licensee and Authorized Representative. All client files had updated appraisals. Continued on LIC809C

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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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: AUTISTRY STUDIOS	FACILITY NUMBER: 216803659
	VISIT DATE: 05/26/2026

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Continued from LIC809

Facility's fire extinguishers were last inspected October 2025. Facility's last emergency/disaster drill was conducted May 2026. Facility's carbon monoxide detectors were tested and operational. Facility's smoke detectors are hardwired and were last inspected March 2026. Facility's Emergency Disaster Plan was last reviewed and updated February 2026.

LPA obtained the following documents to update the facility file:

Emergency Disaster Plan (LIC 610D)
LIC500 (Personnel Report)
Lease/Control of Property

LPA requested the following documents for facility file:

Designation of Facility Responsibility (LIC 308)
Updated Liability Insurance

Documents to be submitted to Community Care Licensing (CCL) by due date of 06/26/2026.

No Deficiencies Cited during visit.

Exit interview conducted. Copy of report and LIC9102 (Technical Violations/Advisories) discussed and provided to Office Manager. 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

LIC809 (FAS) - (06/04)

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