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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486802051
Report Date: 05/19/2023
Date Signed: 05/19/2023 12:47:23 PM

Document Has Been Signed on 05/19/2023 12:47 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:DIFFERENT STROKESFACILITY NUMBER:
486802051
ADMINISTRATOR:LOPEZ FOX, PAMELAFACILITY TYPE:
775
ADDRESS:825 EMPIRE STREETTELEPHONE:
(707) 428-3515
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 15CENSUS: 12DATE:
05/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Joseph Greene, Facility DirectorTIME COMPLETED:
01:04 PM
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Licensing Program Analyst (LPA) Karina Canela arrived unannounced to conduct an Annual Required - 1 Year inspection and met with Director Joseph Greene.

LPA toured the facility; all exits were unobstructed. LPA observed clients participating in activities. Different Strokes is currently providing in-person services Monday - Friday, while providing alternative services for two participants.
LPA reviewed staff and client records. Staff have current CPR/first aid certifications in file. Fire extinguisher was charged and serviced 12/28/2022. Cleaning supplies and disinfectants were observed locked and inaccessible. LPA observed soap & paper towels available in bathrooms. The facility does not handle client cash resources and does not administer medication. Water was tested and was within regulation of 105 - 120 degrees F.

LPA consulted with Director regarding the client medical assessments. LPA requested additional records be submitted for review.


LPA obtained the following updated records prior to today's visit:
ยท LIC 308 Designation of Facility Responsibility; LIC 500 Personnel Report; LIC 610D Emergency Disaster Plan; LIC 9020 Register of Facility Clients;

Exit interview conducted with Director, 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: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2023
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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