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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486801146
Report Date: 06/20/2024
Date Signed: 06/20/2024 12:54:54 PM

Document Has Been Signed on 06/20/2024 12:54 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:PRIDE INDUSTRIESFACILITY NUMBER:
486801146
ADMINISTRATOR/
DIRECTOR:		DARELYN PAZDELFACILITY TYPE:
775
ADDRESS:2339 COURAGE DRIVE, STE DTELEPHONE:
(707) 399-3601
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 30CENSUS: 13DATE:
06/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Rita Morrison, Workforce Inclusion ManagerTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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At approximately 9:15 a.m., Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a Required - 1 Year inspection and met with Workforce Inclusion Manager Rita Morrison. LPA was informed that Darelyn Pazdel is no longer regularly working on-site as she has moved into a new role as the Vice President of Workforce Inclusion. LPA was informed that Rita Morrison is in charge of the day-to-day operations of the facility and is listed as a designated responsible party. LPA was informed that Pride Industries currently provides in-person services Monday through Friday. The facility also provides alternative services such as various zoom classes, activity packets, and community outings.

At approximately 10:00 a.m., LPA conducted a walk-through of the facility and observed the following: there were 5 staff working and LPA was informed that facility maintains a 1:3 ratio of staff to clients which if within regulation. There were 11 clients attending the behavior support program today; LPA was informed that 4 clients were out for a walk and were going to the mall and 7 clients were present and engaged in activities (movies, jewelry making, crossword puzzles, conversations, etc.) of their choosing. LPA was informed that 2 additional clients attended this morning via Zoom for an educational session on the topic(s) of the day as scheduled on the facility's Zoom activity calendar which is posted for clients in care to view and can participate in these sessions if they choose. Based on the calendar and conversations with staff, these sessions occur daily and topics vary from personal rights, anger management, virtual vacations, book club, safety and more.

LPA observed all exits unobstructed, chemicals stored in locked cabinets, soap & paper towels were available in 2 of 2 bathrooms, and water temperatures tested within the allowable range of 105-120 degrees Fahrenheit per Title XXII regulations. LPA observed that facility has a first aid kit and emergency supplies. Fire extinguisher was charged and last serviced April 2024. Carbon monoxide detector was tested and operational. Facility is hardwired and passed the last test performed by Bay Alarm 2/2024.

Continued on 809-D...
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: PRIDE INDUSTRIES
FACILITY NUMBER: 486801146
VISIT DATE: 06/20/2024
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Continued from 809...

At approximately 10:45 a.m., LPA reviewed 5 staff and 5 client records. 4 of 5 staff have current training certifications in First Aid & Cardiopulmonary Resuscitation (CPR) as required. LPA advised Facility Manager to ensure all staff have the required training. 5 of 5 staff have all the required documentation per regulation. 5 of 5 client records have all the required documentation per regulation. 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 06/30/2024:
- 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
- Copy of Current Facility Lease Agreement

Exit interview conducted with Rita Morrison, whose signature on this document confirms receipt.
**No deficiencies cited during this inspection
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
LIC809 (FAS) - (06/04)
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