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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486801953
Report Date: 05/31/2024
Date Signed: 05/31/2024 12:46:40 PM

Document Has Been Signed on 05/31/2024 12:46 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:RICHARD'S HAPPY HOMEFACILITY NUMBER:
486801953
ADMINISTRATOR/
DIRECTOR:		TROY RICHARDFACILITY TYPE:
735
ADDRESS:254 DONEGAL COURTTELEPHONE:
(707) 448-2838
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 6CENSUS: 4DATE:
05/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:10 AM
MET WITH: Licensee, ,Ocie Mae RichardTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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At approximately 8:10 AM, Licensing Program Analyst (LPA) Mutialu conducted an unannounced Annual Required inspection to this facility and met with Licensee, ,Ocie Mae Richard. At approximately 8:40AM, LPA toured the building and grounds which was not found to be clean and in good repair. C1 room smelled of urine and was unclean. Per Licensee C1 will not allow Licensee to clean room and when room is cleaned, C1 takes everything out again. Licensee is unsure how to handle this due to Personnel Rights. LPA advised Licensee it is ok to clean room and to mention to RO/RP regarding possibly adding to care plan/IPP. LPA observed debris and clutter in the back yard. Per licensee renovations for back unit are in progress. Licensee cleared as much clutter as possible during inspection. LPA observed side fences are missing and replaced will orange netting, top stair missing wood tile, back door hallway floor has wood instead of linoleum. Per licensee in the middle of renovations. No safety hazards observed. LPA observed all walkways and exits to be unobstructed. The amount of fresh and non-perishable foods was within regulation. Toxins are secure and not accessible to clients. Medication is centrally stored and secure. There is a sufficient supply of hygiene products and linens on hand for client use. Mattress pads were in place or available for Client use. Water temperature measured within regulation between 113.9 and 114.3 degrees F at faucets three of three faucets accessible to clients. Two of two fire extinguishers inspected were charged. Eight of eight smoke detectors were tested and found to be in working order. Carbon Monoxide detector was present. LPA advised Licensee disaster Drills are to be conducted monthly.

At approximately 10:00AM, LPA reviewed 4 of 4 Client records and 2 of 4 Staff records, which were all found to be well organized, thorough and contained documentation. LPA advised Licensee LIC613 is required for all clients and all appraisals to be current. First aid and CPR certification were current in staff files reviewed. Administrator's Certificate was current with an expiration date of 07/18/2024.


Continued on LIC809C
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Stefanie Mutialu
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2024
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: RICHARD'S HAPPY HOME
FACILITY NUMBER: 486801953
VISIT DATE: 05/31/2024
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Continued from LIC809


Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit:

LIC 500 Personnel Summary
LIC 602 (updated)
LIC610- Disaster Plan (updated with two evacuation sites-1 non local site)
ANS (Updated)
LIC613
P&I Logs
Emergency Disaster Drill Log
Surety Bond (recent date)


No citations were issued during today’s visit.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Stefanie Mutialu
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024
LIC809 (FAS) - (06/04)
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