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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216804095
Report Date: 01/17/2024
Date Signed: 01/17/2024 12:19:04 PM

Document Has Been Signed on 01/17/2024 12:19 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: 13DATE:
01/17/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Program Director, Riley ReckTIME COMPLETED:
12:00 PM
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At approximately 9:40AM, Licensing Program Analyst (LPA) Felias arrived unannounced to continue a Required 1 Year visit and met with Program Director, Riley Reck. Facility is an Social Rehabilitation Program that provides care and assistance for Adults with Mental Health Diagnoses. Upon arrival, LPA was informed that there were 14 Clients in care with 6 staff members on-site.

At approximately 9:50AM, LPA reviewed client files and client medications. Client files were found to be well organized, thorough and contained the required documentation. Client Medications were centrally stored and secure. LPA conducted interviews.

LPA is requesting the following documents to update the facility file:
  • Designation of Facility Responsibility (LIC308)
  • Emergency Disaster Plan (LIC610D)
  • Updated Personnel Report (LIC500)
  • Register of Clients/Residents (LIC9020)


Facility Documents to be submitted to Community Care Licensing (CCL) by due date of Saturday, 02/16/2024.

No Deficiencies cited during visit.

Exit interview conducted. Copy of report discussed and provided to Program Director. Signature on form confirms receipt of documents.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2024
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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