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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803956
Report Date: 03/30/2023
Date Signed: 03/30/2023 03:39:04 PM

Document Has Been Signed on 03/30/2023 03:39 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:CONNECTED LIVING VACAVILLEFACILITY NUMBER:
486803956
ADMINISTRATOR:TRAIL, SARAFACILITY TYPE:
735
ADDRESS:82 MANZANITA DRIVETELEPHONE:
(925) 826-6830
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 3CENSUS: 3DATE:
03/30/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Cederick Tanner, Lead StaffTIME COMPLETED:
03:55 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
On 3/30/2023, Licensing Program Analyst (LPA), Tobola arrived unannounced for the purpose of following up on a self-reported incident. LPA was greeted by Facility Director, Cedric Tanner (DR). Incident reports that client, (C1) had been arrested for demonstrating inappropriate sexual behaviors while out in the community. Upon review of client records, LPA found that C1 is able to leave the facility unassisted. DR and LPA discussed updated ISP and implementation of supervision and level of care for C1.

Client C1 was not present at the facility at the time of inspection. LPA was informed that C1's responsible party is involved in restricting C1's car and cellphone usage to reduce outings at this time. Facility is partnering with NBRC to develop a plan on assisting with the behaviors and overall safety of C1. NBRC has been in recent contact and visitation to the facility regarding the same incident.

Administrator has submitted request to NBRC for additional staffing support with determination currently pending. Facility will be submitting updated ISP and/or Needs & Service Plan to CCLD once received.

No deficiencies cited during today's visit.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE: DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/30/2023
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 1