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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803953
Report Date: 09/10/2021
Date Signed: 09/10/2021 10:38:49 AM

Document Has Been Signed on 09/10/2021 10:38 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
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:HIGH POINTE RESIDENCESFACILITY NUMBER:
486803953
ADMINISTRATOR:CHILDS, WESTLUNDFACILITY TYPE:
735
ADDRESS:1737 YORK ST.TELEPHONE:
(707) 712-8038
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 4CENSUS: 0DATE:
09/10/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Dante Ward, Licensee TIME COMPLETED:
10:48 AM
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Licensing Program Analyst (LPA) Karina Canela arrived at High Pointe Residences to conduct an unannounced Annual Required inspection on 09/10/2021. LPA met with Licensee Dante Ward. Currently the facility does not have clients in care. LPA & Licensee discussed COVID-19 precautions and Emergency Disaster Drills to be conducted every 3 months. LPA toured the facility with Licensee.

During today’s visit LPA observed the following items:
· COVID-19 screening station at front entrance.
· All exits were unobstructed
· Required furnishings in all 4 client bedrooms
· A Hot Tub in the backyard, which was locked.
· Required postings (Personal Rights, Emergency plan/numbers, CCLD complaint poster, Emergency Disaster Plan, House Rules, and visitor policy).
· Lockable cabinets for medications and toxins.


LPA & Licensee discussed records to be maintained at an Adult Residential Care Facility. LPA will send Licensee COVID-19 precaution postings.

No deficiencies cited during today's inspection
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Karina Canela
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2021
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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