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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480100774
Report Date: 09/19/2023
Date Signed: 09/19/2023 12:27:04 PM

Document Has Been Signed on 09/19/2023 12:27 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:STRONG FAMILY HOMEFACILITY NUMBER:
480100774
ADMINISTRATOR:HATTIE STRONGFACILITY TYPE:
735
ADDRESS:141 HOLLYWOOD AVENUETELEPHONE:
(707) 644-1489
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY: 6CENSUS: 3DATE:
09/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Hattie Strong, AdministratorTIME COMPLETED:
12:25 PM
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At 10:05 AM Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced for the purpose of conducting an annual/required inspection. LPA was met by the Licensee Hattie Strong and toured the facility and grounds. There are currently 3 residents residing at the facility. There were two staff at the time of inspection.

The facility was clean and organized. All exits were unobstructed. Smoke detectors and carbon monoxide detectors working. Hot water tested was within regulatory range of 105 degrees F and 120 degrees F. Emergency fire drills occur regularly and are current. Grounds free of any apparent hazards. Client bedrooms are clean and adequately furnished, and have items to reflect their personal interests. Medications are locked and stored away. There are 3 kitchens on the premises, with ample perishable and nonperishable foods stored as required per regulation. Hygiene products and linens in sufficient supply. Residents attend Day Program or work and are included in family activities and attend church and prayer services regularly. Back yard has an area for play, basketball, reading, and enjoying a picnic supper at outside seating.

3 Client files were reviewed and found to be current, including admission agreement; health screening; personal rights. Ledgers for 2 clients were current through August 2023. 3 staff records were reviewed and found to be current, including health screening; training, and first aid/cpr . Administrator certificate expires 12/11/2024.

No deficiencies found at the time of inspection. No citations issued.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2023
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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