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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804045
Report Date: 08/29/2024
Date Signed: 09/10/2024 05:07:18 PM

Document Has Been Signed on 09/10/2024 05:07 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:KEARNEY COMMUNITY SUPPORT HOMEFACILITY NUMBER:
486804045
ADMINISTRATOR/
DIRECTOR:		COLEMAN, CLARENCE JR.FACILITY TYPE:
735
ADDRESS:100 KEARNEY WAYTELEPHONE:
(707) 548-3646
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 4CENSUS: 4DATE:
08/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Clarence Coleman, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Jill Nakagawa conducted an unannounced Annual Inspection and was greeted by Administrator Clarence Coleman Jr..

This facility is clean and well-organized. All 4 client bedrooms are well appointed with the required furnishings and linens as per regulation. The facility provides hygiene items to the clients. There are currently 4 clients in care; however they were all attending Day Program at the time of inspection. LPA conducted a tour and inspection of the indoor and outdoor portions of the facility. The home was observed organized and at a comfortable temperature. Fire extinguisher was charged and current. The kitchen was clean and organized. The refrigerator and freezer were well stocked with fresh foods and the pantry was well stocked with non-perishables. Emergency lights, smoke detectors and carbon monoxide detector were present and operational. Exits were observed to be unobstructed. Fireplace was appropriately screened. The living room is homey and comfortable. The outside area has 2 sheds; both containing household items and tools. The facility has a well appointed backyard with comfortable seating and shaded areas, and plenty of outdoor activities. In addition, the Administrator barbecues dinner frequently which provides great social interaction between the clients and the staff.

LPA reviewed 5 staff and 4 client records. 3 of 4 client records were complete. Administrator is working with Regional Center to update 1 client record. 2 of 5 staff files were missing First Aid renewal.

There were no deficiencies cited at the time of inspection.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2024
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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