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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486802051
Report Date: 04/15/2025
Date Signed: 05/19/2025 11:55:34 AM

Document Has Been Signed on 05/19/2025 11:55 AM - 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: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: 9DATE:
04/15/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Licensee- Pamela Lopez Fox TIME VISIT/
INSPECTION COMPLETED:
11:55 PM
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At approximately 9:30 AM Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conduct an Annual Required - 1 Year inspection and met with licensee Pamela Lopez Fox

At approximately 9:50 AM 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 other clients as needed.

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.

Different Strokes has activities including: arts/craft, music, animal therapy, television, books, games, patio with sun and shade, basketball hoop, independent living and life skills, advocacy and helps participants with day trips. Different Strokes makes day trips to clean local parks in the adopt-a-street and adopt-a-park program.

Different Strokes is vendorized as a Behavior Management Program with staffing ratio of one (1) to three (3) in house and one (1) to two (2) in community outings.

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. Fire extinguisher was fully charged and serviced 12/04/2024. Last fire drill was conducted on 03/11/2025. Hardwired smoke detectors we inspected by outside vendor on 01/08/2025

Continued on LIC809C
NAME OF LICENSING PROGRAM MANAGER: Kimberley Mota
NAME OF LICENSING PROGRAM ANALYST: Star Stevenson
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/15/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: DIFFERENT STROKES
FACILITY NUMBER: 486802051
VISIT DATE: 04/15/2025
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Continued for LIC809

CCL recently obtained the following for our files on 03/06/2025
LIC 500 Staff Roster
LIC 308 Designation of Facility Responsibility
LIC 610D Emergency Disaster Plan
LIC 9020 Faciltiy Residents

Today on 04/15/2025
LPA received copies of current Liability Insurance.

Exit interview conducted with Licensee, whose signature on this document confirms receipt
**No deficiencies cited during this inspection
NAME OF LICENSING PROGRAM MANAGER: Kimberley Mota
NAME OF LICENSING PROGRAM ANALYST: Star Stevenson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
LIC809 (FAS) - (06/04)
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