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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 236803761
Report Date: 08/07/2023
Date Signed: 08/07/2023 10:31:34 AM

Document Has Been Signed on 08/07/2023 10:31 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:COMMUNITY CONNECTION, THEFACILITY NUMBER:
236803761
ADMINISTRATOR:PEREZ-MORAN, RODRIGOFACILITY TYPE:
775
ADDRESS:521 CHESTNUT STTELEPHONE:
(707) 964-1489
CITY:FORT BRAGGSTATE: CAZIP CODE:
95437
CAPACITY: 30CENSUS: 16DATE:
08/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Dennis DelucaTIME COMPLETED:
10:45 AM
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At approximately 8:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived unannounced at this Licensed Day Program to conduct an Annual Required Inspection. LPA met with Dennis Deluca and toured the facility. This Day Program operates Monday -Friday. There were 16 Clients and 16 Staff present at the time of this inspection. The facility consists of offices, two large activity rooms, a quiet room, changing area, 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 or go into the community for lunch. Snacks are available for clients.
Toxins are centrally stored in a locked closet in a hallway of the facility. Water temperature measured within regulation between 105 and 120 degrees at faucets accessible to clients. Client money is secure and not commingled. Facility has a locked area where medications are stored. The only medication on site is brought by the client each day. At approximately 9:15AM, LPA reviewed 5 of 16 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.

No deficiencies were found in the areas inspected, No citations issued during today’s visit.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2023
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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