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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480100774
Report Date: 10/28/2024
Date Signed: 10/28/2024 10:21:23 PM

Document Has Been Signed on 10/28/2024 10:21 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/
DIRECTOR:		HATTIE STRONGFACILITY TYPE:
735
ADDRESS:141 HOLLYWOOD AVENUETELEPHONE:
(707) 644-1489
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY: 6CENSUS: 3DATE:
10/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Hattie Strong TIME VISIT/
INSPECTION COMPLETED:
04:31 PM
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At 1:15 PM Licensing Program Analyst (LPA) Araceli Canela arrived unannounced for the purpose of conducting an annual/required 1 year inspection. LPA met with staff Shawn Fashawn and Licensee, Hattie Strong and toured the facility and grounds. There are currently 3 clients residing at the facility.

This home is a two level home and all client bedrooms are located on the main level of the home. It is licensed for 6 clients, of which one can be non-ambulatory. The facility was clean, organized and at a comfortable temperature. All exits were unobstructed. Smoke detectors and carbon monoxide detectors are operational. Fire extinguisher was charged and serviced on, 7/29/2024. Hot water tested was within regulatory range of 105 degrees F and 120 degrees F. Facility grounds are free of any apparent hazards. Client bedrooms are clean and adequately furnished, and have items to reflect their personal interests. Medications are centrally stored an locked. There are perishable and nonperishable foods stored as required per regulation. Hygiene products and linens are sufficient supply. Clients attend Day Program or work and are included in family activities and attend church and prayer services regularly. LPA interacted with all 3 clients, for several minutes when they returned home from day program/job.

3 Client files were reviewed and found to be current, including admission agreement; health screening; personal rights. Staff records were reviewed and found to be current, including health screening; training, and first aid/cpr expires 8/2025. Administrator certificate expires 12/11/2024.

LPA went over age exception needed for 2 clients with, House Manager, Lisa Strong-Dodson; who expressed she was not sure if one was requested 10-12 years ago. LPA will review file and notify facility what is needed for the age exception, if one is not in file.
Continue see report LIC809-C
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Araceli Canela
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 HOME
FACILITY NUMBER: 480100774
VISIT DATE: 10/28/2024
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No deficiencies cited during today's visit.

LPA requested the following documents be sent to CCL by COB 11/27/2024:

LIC 500 Personnel Summary
LIC 9020 Register of Facility client’s/client’s
Copy of Administrator Certificate
Updated facility sketch
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Araceli Canela
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2024
LIC809 (FAS) - (06/04)
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