<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486800622
Report Date: 03/18/2025
Date Signed: 03/18/2025 03:09:20 PM

Document Has Been Signed on 03/18/2025 03:09 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:JEAN'S CARE HOME IIFACILITY NUMBER:
486800622
ADMINISTRATOR/
DIRECTOR:		DEARMON, JEAN/LARUE, CARLAFACILITY TYPE:
735
ADDRESS:1122 TUOLUMNE STREETTELEPHONE:
(707) 557-9422
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY: 6CENSUS: 1DATE:
03/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Jean Dearmon-Stephens, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
At approximately 1:00 PM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year inspection and was greeted by staff member Bobbie Dearmon. Administrator Jean Dearmon-Stephens arrived at 1:10 PM. Jean's Care Home II is Licensed as an Adult Residential Facility (ARF). The facility is a multi-story house with a pool in the back yard. The facility has an approved fire clearance for six (6) clients between the ages of eighteen (18) and fifty-nine (59). One (1) client can be non-ambulatory. Upon arrival, LPA was informed that there was one (1) client in care. During the inspection, the client was away at a day program. At approximately 1:20 PM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation.

At approximately 1:30 PM, LPA toured the facility with Administrator Dearmon-Stephens . All exits were clear and unobstructed. All three (3) fire extinguishers were purchased on 10/29/2024. Fire Department inspected and cleared the facility on 1/17/2025. Food supply was sufficient. The facility was sufficiently lighted. LPA inspected three (3) client bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for clients. Toxins were observed to be stored inaccessible to clients. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills quarterly. The last disaster drill was conducted on 2/24/2025. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational.

Continued on 809-C
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: JEAN'S CARE HOME II
FACILITY NUMBER: 486800622
VISIT DATE: 03/18/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
...Continued from 809

At approximately 2:00 PM, LPA reviewed one (1) client file. One (1) of one (1) client files were found to be well organized and thorough with all required documentation. LPA reviewed two (2) staff files. All staff files were observed to have all required documentation including First Aid and CPR certification and proper training documentation. LPA spot checked Medication for one (1) client. LPA observed all medications to be centrally stored, secure and with proper documentation. Client’s monies for personal and incidental (P&I) items are not managed by the facility.

Jean Dearmon-Stephens Administrator Certification 7034420735 is current with an expiration date of 3/30/2025.

LPA requested the following documents be submitted to Community Care Licensing by 4/18/2025:



LIC 500 Personnel Report
LIC 308 Designation of Responsibility
LIC 610D Emergency Disaster Plan

No deficiencies cited during today's visit.

Exit interview conducted. Copy of report and discussed and provided to Administrator Dearmon-Stephens. Signature on form confirms receipt of documents.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
LIC809 (FAS) - (06/04)
Page: 2 of 2