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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803406
Report Date: 10/02/2024
Date Signed: 10/02/2024 12:58:32 PM

Document Has Been Signed on 10/02/2024 12:58 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 PARKWAYFACILITY NUMBER:
486803406
ADMINISTRATOR/
DIRECTOR:		BRITTANY BERRINGERFACILITY TYPE:
775
ADDRESS:950 MASON STTELEPHONE:
(707) 447-3767
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 75CENSUS: 67DATE:
10/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Administrator, Brittany BerringerTIME VISIT/
INSPECTION COMPLETED:
01:05 PM
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At approximately 9:50AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Required 1 Year visit and met with Administrator, Brittany Berringer. Facility is an Adult Day Program for Adults with Disabilities. Facility has an approved fire clearance and capacity for 75 Ambulatory Clients, of which 20 Clients can be Non-Ambulatory. Upon arrival, LPA was informed that there were 67 clients attending Day Program and 28 staff members on-site.

At approximately 10:05AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 10:20AM, LPA conducted a walk-though of the facility with Administrator. LPA observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility is a one story building with 7 classrooms, 5 bathrooms, 3 staff offices, and common areas. Facility has an Infection Control plan on file. Toxins were observed to be stored inaccessible to clients. There was an appropriate supply of cleaning products, hygiene products and paper products available for clients. Hot water temperatures for a sample size of 5 facility sinks were within Title 22 regulations of 105 to 120 degrees Fahrenheit. Per Administrator, clients bring their own snacks and lunches to program and facility contracts with R&D services for transportation needs.

At approximately 11:00AM, LPA reviewed staff and client files, client medications, and client P&I monies. All files were all found to be well organized, thorough and contained the required documentation. Staff files were all found to have current First Aid and CPR certification. Medication was centrally stored and secure. P&I monies were documented, secure and not commingled. Facility's fire system including fire extinguishers, carbon monoxide and smoke detectors, and sprinklers were last inspected September 2024. Facility's last emergency/disaster drill was conducted September 2024.

Continued on LIC809C
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
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 PARKWAY
FACILITY NUMBER: 486803406
VISIT DATE: 10/02/2024
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Continued from LIC809

LPA requested the following documents to update facility file:
  • Designation of Facility Responsibility (LIC 308)
  • Updated Emergency Disaster Plan (LIC 610D)
  • Updated Personnel Report (LIC 500)
  • Surety Bond
  • Updated Liability Insurance

Documents to be submitted to Community Care Licensing (CCL) by due date of 11/02/2024.

No Deficiencies Cited during visit.

Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
LIC809 (FAS) - (06/04)
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