<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803027
Report Date: 05/16/2024
Date Signed: 05/16/2024 02:16:34 PM

Document Has Been Signed on 05/16/2024 02:16 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:ONE STEP AT A TIME CARE HOMEFACILITY NUMBER:
486803027
ADMINISTRATOR/
DIRECTOR:		VILLALOBOS-SANTOS, MARIAFACILITY TYPE:
735
ADDRESS:503 MARINA BLVDTELEPHONE:
(707) 427-8553
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY: 6CENSUS: 4DATE:
05/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Maria Villalobos-Santos, Administrator TIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
At approximately 9:30 AM, Licensing Program Analyst (LPA) Stefanie Mutialu conducted an unannounced Annual Required inspection to this facility and was greeted by Licensee Fabricio Santos. Administrator/Licensee Maria Villalobos-Santos arrived shortly after. At approximately 9:41AM, LPA and Administrator/Licensees toured the building and grounds which was found to be clean but not in good repair. LPA observed hallway bathroom two toilet seat showing signs of wear and tear. The toilet seat is partially brown (wood) and partially white (overlay).The parts of the toilet seat do not have white protective covering. LPA observed laundry room blinds are not working and individual blinds are bent and crooked. LPA observed backyard has debris that includes non hazardous wood. Client bedroom 3 has unfinished ceiling square hole, covering is brown, and part of ceiling covering is missing next to patch. that is temporarily repaired, in need of permanent patch repairs including seal and paint to ensure clients safety and health. LPA advised Administrator/Licensee facility must be in good repair at all times. Administrator/Licensee agreed to replace toilet seat, blinds, repair C1 bedroom ceiling, and remove debris from backyard. Administrator/Licensee to provide LPA with proof of repair date of 06/16/2024. LPA observed all walkways and exits to be unobstructed. The amount of fresh and non-perishable foods was within regulation. LPA advised Administrator/Licensee that all food must be stored properly and defrosted previously frozen food must have defrost date to ensure food is safe and not expired. Toxins are secure and not accessible to clients. LPA advised Administrator/Licensee sharps drawer must be locked at times. Medication is centrally stored and secure. There is a sufficient supply of hygiene products and linens on hand for client use. Four out four clients rooms were inspected and found to be within regulation. Advised administrator and licensee night lights shall be maintained in hallways and non-private bathrooms. Five out of five water faucets were inspected and found to be within regulation. Water temperature measured within regulation between 108.3 and 110.4 degrees F at faucets accessible to clients.


Continued on 809C
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Stefanie Mutialu
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 11
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: ONE STEP AT A TIME CARE HOME
FACILITY NUMBER: 486803027
VISIT DATE: 05/16/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued from 809

Four out of four smoke detectors and one out of one carbon monoxide detector were inspected and found to to be in working order. Two out of two fire extinguishers were fully charged and inspected on 3/26/2024.LPA advised Administrator/Licensee disaster drills are be conducted quarterly for each shift and documented. Last disaster drill conducted on 02/24/2024.

At approximately 11:10AM, LPA reviewed 4 of 4 Client records and 3 of 4 Staff records, which were all found to be well organized, thorough and contained the required documentation. First aid and CPR certification were current in staff files reviewed. Facility no longer handles clients cash. Administrator's Certificate is expired. Administrator, Maria Villalobos-Santos provided proof to LPA of recertification payment submission of cashed check.

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

LIC500- Personnel Report
LIC610D- Disaster Plan
Staff Training Schedule


Updated copies of the following documents were received during visit to update facility file:
Surety Bond
Administrator Proof of Payment.

No deficiencies were observed in the areas inspected. No citations issued during today’s visit.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Stefanie Mutialu
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC809 (FAS) - (06/04)
Page: 2 of 11