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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 236803321
Report Date: 03/26/2024
Date Signed: 03/26/2024 12:14:22 PM

Document Has Been Signed on 03/26/2024 12:14 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:ENHANCED SERVICESFACILITY NUMBER:
236803321
ADMINISTRATOR:BASHAW, SEANFACILITY TYPE:
775
ADDRESS:915 S. DORATELEPHONE:
(707) 489-1513
CITY:UKIAHSTATE: CAZIP CODE:
95482
CAPACITY: 40CENSUS: 11DATE:
03/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Rebecca WagnerTIME COMPLETED:
12:30 PM
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At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this licensed adult day program unannounced, to conduct an Annual Required inspection. LPA met with Program Manager Rebecca Wagner, toured the building and reviewed records. The Day Program was found to be clean and at a comfortable temperature with all exits free from obstruction. LPA observed two main client areas, furnished with positioning mats and tables. This Day Program works with individuals mobility and range of motion. Facility has PPE supplies stored in a supply closet. There were hand washing stations and hand sanitizer located throughout the building.
LPA reviewed 6 client files which were found to be well organized and contained all the required documentation.
Staff files contained the required documentation of completed training and first aid/CPR certification.
Smoke detectors, carbon monoxide detectors were operational and facility has fire sprinklers throughout.

There were no deficiencies found in the areas inspected.

No citations issued.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2024
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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