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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 236800266
Report Date: 08/22/2023
Date Signed: 08/22/2023 10:33:35 AM

Document Has Been Signed on 08/22/2023 10:33 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:RURAL ADULT PROGRAMFACILITY NUMBER:
236800266
ADMINISTRATOR:SEAN BASHAWFACILITY TYPE:
775
ADDRESS:209 W. MILL STREETTELEPHONE:
(707) 468-8824
CITY:UKIAHSTATE: CAZIP CODE:
95482
CAPACITY: 30CENSUS: 9DATE:
08/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Kerri RichardsonTIME COMPLETED:
10:45 AM
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At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived unannounced at this Licensed Day Program to conduct an Annual Required Inspection. LPA met with Program Manager Kerri Richardson and toured the facility. This Day Program operates Monday -Friday. There were 9 Clients and 6 Staff present at the time of this inspection. The facility consists of offices, a two large activity rooms, a quiet room, changing area, a kitchen, and two bathrooms. LPA observed the facility was a comfortable temperature and found all exits and walkways to be unobstructed. The facility grounds were also kept clean and without hazards. Clients bring lunches most days and the other days clients eat out.
Toxins are centrally stored in a locked closet in a hallway. Water temperature measured within regulation between 105 and 120 degrees at faucets accessible to clients. Some clients bring lunch money to be stored by the program. Money is properly documented and secure. Medications were centrally stored. Clients do crafts and interact with community.

At approximately 9:30AM, LPA reviewed 5 of 9 client files and found files to be thorough and contain current client care assessments and individualized Service Plans. Staff records were also found to be current, including staff first aid and CPR training verification. Disaster drills are conducted monthly. LPA received a copy of the facility surety bond.

LPA received an updated LIC500 during visit.



No citations issued during today's visit.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2023
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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