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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486802051
Report Date: 05/09/2024
Date Signed: 05/09/2024 12:09:21 PM

Document Has Been Signed on 05/09/2024 12:09 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:DIFFERENT STROKESFACILITY NUMBER:
486802051
ADMINISTRATOR/
DIRECTOR:		LOPEZ FOX, PAMELAFACILITY TYPE:
775
ADDRESS:825 EMPIRE STREETTELEPHONE:
(707) 428-3515
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 15CENSUS: 8DATE:
05/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Joseph Greene, DirectorTIME VISIT/
INSPECTION COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Jill Nakagawa 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 8 clients participating in activities. There were 4 staff, including the Director, on site at the time of inspection. Different Strokes is currently providing in-person services Monday - Friday, and providing alternative services for one participant on a regular basis and for other clients as needed.

LPA reviewed facility files: 5 of 5 staff files reviewed were complete and included current CPR/first aid certification. 5 of 5 client files reviewed were complete. LPA requested that most recent Physician's Reports be included in client files. Fire extinguisher was fully charged and serviced 12/04/2023. Last fire drill was conducted on 03/11/2024. 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 requested the following updated records:
ยท LIC 500 Personnel Report; 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: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
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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