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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486801146
Report Date: 05/25/2023
Date Signed: 05/25/2023 02:00:56 PM

Document Has Been Signed on 05/25/2023 02:00 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:PRIDE INDUSTRIESFACILITY NUMBER:
486801146
ADMINISTRATOR:DARELYN PAZDELFACILITY TYPE:
775
ADDRESS:2339 COURAGE DRIVE, STE DTELEPHONE:
(707) 399-3601
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 30CENSUS: 30DATE:
05/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Rita Morrison, Rehabilitation Services Manager TIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Karina Canela arrived unannounced to conduct a Required - 1 Year inspection and met with Workforce Inclusion Manager Rita Morrison.
LPA conducted a walk-through of the facility and all exits were unobstructed. Pride Industries is currently providing in-person services Monday through Friday. The facility also provides alternative services such as various zoom classes, activity packets, and community outings. Regarding the Home Community-Based Services (HCBS) Final Rule, Pride Industries does not have plans to close the program and will continue to provide services to individuals. Pride Industries plans to be incompliance with HCBS final rule by implementing new services or work programs as an option for current or future individuals.
LPA observed soap & paper towels were available in 2 of 2 bathrooms. Water temperature was tested. Fire extinguisher was charged and serviced 01/24/2023. LPA reviewed staff and client records. Staff have current training certifications in First Aid & Cardiopulmonary Resuscitation (CPR) as required. The facility does not handle client cash resources or manage medication.

LPA requested the following updated forms to be submitted to Community Care Licensing by 06/26/2023:
· LIC 308 Designation of Facility Responsibility (1 person per form)
· LIC 500 Personnel Report
· LIC 400 Affidavit Regarding Client/Resident Cash Resources (indicate if not handling cash for clients)
· LIC 610D Emergency Disaster Plan
· LIC 9020 Register of Facility clients

Exit interview conducted with Rita Morrison, whose signature on this document confirms receipt.
**No deficiencies cited during this inspection
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Karina Canela
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2023
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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