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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803956
Report Date: 02/25/2025
Date Signed: 02/26/2025 01:53:08 PM

Document Has Been Signed on 02/26/2025 01:53 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:CONNECTED LIVING VACAVILLEFACILITY NUMBER:
486803956
ADMINISTRATOR/
DIRECTOR:		KATRINKA TRAILFACILITY TYPE:
735
ADDRESS:82 MANZANITA DRIVETELEPHONE:
(925) 826-6830
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 5CENSUS: 3DATE:
02/25/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Cedric Tanner, DirectorTIME VISIT/
INSPECTION COMPLETED:
02:10 PM
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At approximately 10:15 AM, Licensing Program Analysts (LPAs) Julie Florio and Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and were greeted by Cedric Tanner, Director. Facility is an Adult Residential Facility (ARF) with three clients currently care. All three clients attend day programs and two recently started part-time work. All were away during today's inspection. Facility is vendorized with North Bay Regional Center (NBRC).

At approximately 10:30 AM, LPAs initiated a tour of the facility with Director and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. LPAs observed the CCLD reporting poster and personal rights poster hanging in the front hallway of the facility. Water temperatures in clients' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPAs observed a supply of clean linens and hygiene and paper products available for clients. Clients' bedrooms were inspected and have all of the required furnishings as outlined in Title 22 regulations. LPAs observed a structure built in the garage which is currently being used for Director's sleeping quarters and centrally stored medications. Director states the room was built approximately one (1) year ago. LPAs spoke on the telephone with Administrator's daughter, Sarah Trail, who states that facility does not have a permit for the construction of this room, (see LIC809D and LIC421IM). LPAs observed cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked in staff room in the garage. There is a shaded seating area and outdoor space for activities in the backyard. Facility has chess, video games, a computer, outdoor activities such as tether ball, and facility staff take the clients to the gym twice a week as well as a boxing class on the weekends. Director states that facility plans at least two trips per year and other smaller getaways with the clients.

Continued on LIC809C...
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2025
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 5
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: CONNECTED LIVING VACAVILLE
FACILITY NUMBER: 486803956
VISIT DATE: 02/25/2025
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Continued from LIC809...

Each client has their own internet access device. Facility has internet access available to clients in care, and the phone was tested an operational during today's inspection.

Facility's fire extinguisher were observed charged and was last serviced 1/2025. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Facility conducts monthly disaster drills, and the most recent drill was conducted 2/2025. LPAs advised Director to ensure drills are conducted on all shifts. LPAs observed facility's infection control plan and emergency disaster plan which was last updated 4/2024. LPAs observed a supply of PPE, emergency supplies, a first aid kit, flashlights, and backup battery generator for emergency preparedness.

At approximately 11:30 AM, LPAs reviewed three (3) staff files and three (3) client files. Three (3) of three (3) staff files reviewed have all the required paperwork and proof of current First Aid and CPR training. Three (3) of three (3) client files reviewed have all the required paperwork. Facility coordinates medical and dental visits for the clients and takes them to and from their appointments.

At approximately 12:45 PM, LPAs reviewed medications and medication records which are maintained and stored in compliance with regulation. However, LPAs informed Director that facility shall utilize that centrally stored medication destruction record (LIC622) as required per regulation in order to operate within compliance. Facility does not manage P&I for clients. Director states clients mange their own cash resources through their payee, NewLeaf.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, or repeat violations within a 12 month period, may result in a civil penalty assessment.



**An Immediate Civil Penalty in the total amount of $500 is being assessed for the observed un-permitted structure built in the garage which is currently being used for Director's sleeping quarters, which is a fire clearance violation and immediate health, safety, and/or personal rights violation to persons in care, (see LIC421IM).**

continued on LIC809C...
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025
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: CONNECTED LIVING VACAVILLE
FACILITY NUMBER: 486803956
VISIT DATE: 02/25/2025
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Continued from LIC809C...

Exit interview conducted with Director, whose signature on form confirms receipt. Appeal rights provided.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 02/26/2025 01:53 PM - It Cannot Be Edited


Created By: Julie Florio On 02/26/2025 at 01:30 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: CONNECTED LIVING VACAVILLE
FACILITY NUMBER: 486803956

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80020(a)
Fire Clearance
(a) All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in ensuring the facility's fire clearance accurately reflects the current facility layout, as evidenced by an un-permitted, new structure observed in the garage which staff are sleeping in, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/27/2025
Plan of Correction
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Licensee to submit a new facility sketch which accurately reflect the facility's current layout to include the new structure in the garage to CCL by POC due date 02/27/2025.
Licensee to complete inspection with the Local Fire Marshall for a new fire clearance by POC due date 03/27/2025.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Bethany Moellers
LICENSING EVALUATOR NAME:Julie Florio
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2025


LIC809 (FAS) - (06/04)
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