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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 236803786
Report Date: 12/14/2023
Date Signed: 12/14/2023 01:32:02 PM

Document Has Been Signed on 12/14/2023 01:32 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:COMMUNITY CONNECTION 2, THEFACILITY NUMBER:
236803786
ADMINISTRATOR:PEREZ MORAN, RODRIGOFACILITY TYPE:
775
ADDRESS:365 CYPRESS STREETTELEPHONE:
(707) 964-4940
CITY:FORT BRAGGSTATE: CAZIP CODE:
95437
CAPACITY: 15CENSUS: 2DATE:
12/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Frankie AvilaTIME COMPLETED:
01:45 PM
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At approximately 11:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived unannounced at this Licensed Day Program to conduct an Annual Required Inspection. LPA met with Program Director Adam Ashford and Program Manager Frankie Avila, toured the facility and reviewed records. This Day Program operates Monday -Friday. There were 2 Clients and 4 Staff present at the time of this inspection. The facility consists of an office, two large activity rooms, a quiet room, 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 but there are snacks available for clients.
Toxins are centrally stored and secure. Water temperature measured within regulation between 105 and 120 degrees at faucets accessible to clients. Client money is not handled by facility. Day Program staff receive resident medication daily from home staff, and ensure the medication is stored securely. Clients do crafts and other activities while at program. At approximately 12:15PM, LPA reviewed 1 of 2 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: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2023
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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