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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803305
Report Date: 11/21/2024
Date Signed: 11/21/2024 04:06:10 PM

Document Has Been Signed on 11/21/2024 04:06 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:PACE WINERY SQUAREFACILITY NUMBER:
486803305
ADMINISTRATOR/
DIRECTOR:		BRITTANY MCEWENFACILITY TYPE:
775
ADDRESS:1955 W TEXAS ST STE 190TELEPHONE:
(707) 426-6932
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 75CENSUS: 46DATE:
11/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Tony Tafolla, Program ManagerTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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At approximately 2:30 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a Required - 1 Year inspection and met with Tony Tafolla, Program Manager (PM). LPA was informed that Brittany McEwen, Program Director was out of the facility for a meeting. Facility provides mostly in-person services, Monday through Friday from 8:00 AM - 2:00 PM. The facility offers Zoom participation for clients who wish to attend from home and provides transportation services for the majority of their clients. Facility is vendorized with North Bay Regional Center (NBRC) and all the clients have a service coordinator.

At approximately 2:50 PM, LPA conducted a walk-through of the facility with PM and observed the following: No clients were present as they left the program for the day. LPA was informed that facility maintains mostly a 1:3 ratio of staff to clients. LPA observed a weekly schedule of activities, events, learning opportunities, and outings planned, these include, arts and crafts, movies, music, cooking, working on computers, social time, educational courses, vocational skills, personal rights training, discussions on current events, shopping, library trips, lunch outings, holiday celebrations, and more.

LPA observed unobstructed exits and chemicals and other items which could pose a risk to clients in care stored in locked cabinets and closets. Soap & paper towels were available in facility bathrooms. Water temperatures in all bathrooms tested within the allowable range of 105-120 degrees Fahrenheit per Title XXII regulations. LPA observed multiple first aid kits, PPE, emergency supplies, and water. LPA advised PM to ensure facility has an emergency food supply. Fire extinguishers were observed charged and were last serviced 9/2024. Facility is hardwired with a sprinkler system which was last inspected 10/2024. Carbon monoxide detectors were tested and operational.

The facility centrally stores and locks any PRN or scheduled medications clients may have per regulation. Facility does not handle client cash resources.

Continued on LIC809C...
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
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: PACE WINERY SQUARE
FACILITY NUMBER: 486803305
VISIT DATE: 11/21/2024
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Continued from 809...

LPA will return to complete annual inspection file review at a later time.

No deficiencies cited during this inspection

Exit interview conducted with Program Manager, whose signature on this document confirms receipt.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC809 (FAS) - (06/04)
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