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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216804095
Report Date: 02/09/2023
Date Signed: 02/09/2023 02:55:12 PM

Document Has Been Signed on 02/09/2023 02:55 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:PROGRESS FOUNDATION - GRAND AVENUEFACILITY NUMBER:
216804095
ADMINISTRATOR:HERNANDEZ, ELIZABETHFACILITY TYPE:
772
ADDRESS:920 GRAND AVENUETELEPHONE:
(707) 257-9704
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY: 16CENSUS: 9DATE:
02/09/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Program Director, Audrey LandTIME COMPLETED:
03:05 PM
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At approximately 11:50AM, Licensing Program Analyst (LPA) Felias arrived unannounced to complete a Post-Licensing Inspection visit and met with Program Director, Audrey Land. Facility is a Social Rehabilitation Facility with a total capacity of 16 Ambulatory clients. Facility currently has 9 clients in care.

Upon arrival at the facility, LPA had their temperature checked and logged. LPA observed COVID-19 signs posted at the entry way and throughout the facility. Facility had sufficient amount of PPE available. All staff present were observed to be wearing a mask. Facility continues to monitor for COVID-19 as evidenced by daily symptom checks for staff, clients, and visitors.

LPA conducted a walk-through of the facility and observed the following: Facility is a single story residence, with 8 bedrooms, 4 full bathrooms and 1 half bathroom. 1 of the 4 full bathrooms and the 1 half-bathroom is ADA accessible. There is also a kitchen area, dining room, laundry room, living room, and three staff offices.

Facility was observed to have a sufficient amount of perishable and nonperishable foods per regulation. Facility has an adequate supply of kitchen tools. All Facility sinks were found to be within regulation with temperatures between the range of 105 degrees F to 120 degrees F.

Medications were observed to be locked and inaccessible to clients in care. There is one laundry area available for Client Use. Toxins and Detergents were observed to be locked and inaccessible to clients in care. Per conversation with Program Director, clients ask staff for detergent when needed.

LPA observed Client rooms to be furnished with appropriate linens per regulation.

Continued on LIC809C
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2023
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: PROGRESS FOUNDATION - GRAND AVENUE
FACILITY NUMBER: 216804095
VISIT DATE: 02/09/2023
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Continued from LIC809

Client bathrooms were supplied with paper towels, liquid hand soap, and hand-washing signs. Facility was observed to have an adequate supply of the following products available for clients such as: extra linens, grooming, hygiene, and paper products.

Facility has an Emergency Disaster Plan in place. Fire extinguishers were last charged April 2022. Facility has a central fire alarm system that is directly connected to the Fire Department. Facility's last fire drill was conducted December 2022.

Per conversation with Program Director, staff files are located electronically at their headquarters in Napa and San Francisco. Client Files are located at facility for review if needed.

LPA and Program Director discussed the following:
  • Covid and Influenza A Protocols
  • N95 Fit Testing
  • Staffing
  • Incident Reports
  • Training
  • Annual Inspections
  • Review of Staff and Client Files

No Deficiencies cited during visit.

Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2