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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803305
Report Date: 01/02/2025
Date Signed: 01/02/2025 11:30:58 AM

Document Has Been Signed on 01/02/2025 11:30 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: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: 40DATE:
01/02/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Brittany McEwen, Program DirectorTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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At approximately 9:30 AM, Licensing Program Analysts (LPAs) Julie Florio and Robert Frank arrived unannounced to conduct a Case Management - Annual Continuation inspection and met with Brittany McEwen, Program Director (PD), and Tony Tafolla, Program Manager (PM) was contacted and arrived approximately 10 minutes later.

At approximately 10:00 AM, LPAs initiated file review of six (6) staff and six (6) client files. Six (6) of six (6) staff files reviewed have all the required paperwork per regulation including proof of CPR and first aid certificates and proof of all required training hours completed. Six (6) of six (6) client files reviewed have all required paperwork per regulation.

At approximately 11:00 AM, LPAs reviewed medications and medication records which are maintained and stored in compliance with regulation. LPAs were informed by PM that they mis-poke at previous visit and facility does handle P&I cash resources for clients in care. Facility has one $15,000 surety bond for all five (5) facility locations with $2,000 proportionate share for this specific facility. Cash resources were observed stored and maintained in compliance with regulation.

Updated copies of the following documents are to be submitted to CCL within 30 days of this visit:
  • LIC500 - Personnel Report (updated)

No deficiencies cited during today's inspection. Exit interview conducted with PD whose signature on form confirms receipt of documents.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE: DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/02/2025
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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