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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486800498
Report Date: 10/12/2023
Date Signed: 10/12/2023 03:32:56 PM

Document Has Been Signed on 10/12/2023 03:32 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:MILESTONES ADULT DEVELOPMENT CENTERFACILITY NUMBER:
486800498
ADMINISTRATOR:ALFREDO LACUATA JRFACILITY TYPE:
775
ADDRESS:1 FLORIDA STREETTELEPHONE:
(707) 644-0464
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY: 116CENSUS: 53DATE:
10/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Alfredo Lacuata, AdministratorTIME COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA) Carol Fowler arrived unannounced to conduct this Annual Required inspection and met with Program Director Fred Lacuata. There were a total 53 clients in care for today, with 30 staff providing care. Staff have the required fingerprint clearance.

Facility tour: LPA toured the building and grounds and found facility at comfortable temperature, well lit, clean and in good repair. LPA observed all walkways and exits to be free from obstruction. No bodies of water. Water temperature in bathrooms measured between 117.7 and 114.6 degrees F which are within acceptable range of 105 to 120 degrees F. Toilet facilities are well maintained with paper products. Toxins are locked in storage room. Facility has a sprinkler/smoke detector system that is inspected quarterly by Bay Alarm (09/13/2023) and annually by /Fire department. Fire extinguishers are current and were last serviced on 11/30/2022. The facility has two (2) working Carbon Monoxide detector as required. Program does not handle client cash. Clients supply their own lunches (bag lunches), facility assists with providing snacks or a meal if a client does not have one. No hazards were observed in the indoor and outdoor activity areas. Medication is centrally stored and locked in medicine cart located in the kitchen.
Records reviewed: Last emergency drill conducted on 4/26/2023. Ten client files were reviewed. six staff files were reviewed, records included a health screen and TB test, criminal record clearance, and first aid cards expiring 2025. The staff and consumer ratio at this day program is 1:2.

LPA is requesting the facility to send in updates of the following documents by 10/23/2023:
  • LIC 500- Personnel Report,
  • LIC 308- Designation of Responsibility,
  • LIC 9020 Register of Clients/Residents;
  • LIC 610- Emergency Disaster Plan- Emergency Disaster Evacuation plan.

No deficiencies cited in the areas observed .
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023
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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