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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 236801015
Report Date: 09/05/2023
Date Signed: 09/05/2023 01:37:45 PM

Document Has Been Signed on 09/05/2023 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:HARPE HOME, THEFACILITY NUMBER:
236801015
ADMINISTRATOR:HARPE, CYNTHIAFACILITY TYPE:
735
ADDRESS:800 TOKAY AVENUETELEPHONE:
(707) 489-3685
CITY:UKIAHSTATE: CAZIP CODE:
95482
CAPACITY: 2CENSUS: 1DATE:
09/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Cynthia HarpeTIME COMPLETED:
01:45 PM
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At approximately 12:00PM, Licensing Program Analyst (LPA) Chris Arnhold conducted an unannounced Annual Required inspection to this facility and met with Cynthia Harpe. At approximately 12:15PM, LPA toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. The amount of fresh and non-perishable foods was within regulation. Toxins are secure and not accessible to clients. Medication is centrally stored and secure. There is a sufficient supply of hygiene products and linens on hand for client use. Mattress pads were in place or available for Client use. Water temperature measured within regulation between 105 and 120 degrees F at faucets accessible to clients. Fire extinguishers inspected were charged. Smoke detectors were tested and found to be in working order. Carbon Monoxide detector was present. Disaster Drills are conducted quarterly.

At approximately 12:45PM, LPA reviewed 1 of 1 Client records, which was found to be well organized, thorough and contained the required documentation. Staff First aid certification were current in staff files reviewed. P&I monies were documented, secure and not commingled. Administrator's Certificate renewal was sent to the Administration Certification unit in February. Administrator Certificate has not been received at this time.

No deficiencies were observed in the areas inspected. No citations issued during today’s visit.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2023
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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