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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804093
Report Date: 08/29/2023
Date Signed: 08/29/2023 12:10:43 PM

Document Has Been Signed on 08/29/2023 12:10 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:SPECIAL CARE 3FACILITY NUMBER:
486804093
ADMINISTRATOR:AUJLA, HARJITFACILITY TYPE:
735
ADDRESS:1753 VENTURA WAYTELEPHONE:
(707) 580-5990
CITY:SUISUNSTATE: CAZIP CODE:
94585
CAPACITY: 4CENSUS: 4DATE:
08/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Harjit Aujla, Administrator TIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an Annual Inspection and met with Licensee, Harjit Aujla. At the time of inspection there was one client, and three clients away at day program. There was licensee/administrator and three other staff.

LPA observed a screening station near the entrance that included a visitor sign along with temperature gun. Staff checked LPA temperature. LPA toured the the facility and observed the following: Facility has required postings. The facility was clean and well-organized. The kitchen was organized and had an ample supply of perishable and non-perishable foods. Stored foods in the refrigerator were labeled and dated. Facility was a comfortable temperature and exits were free from obstructions. Hand sanitizer is located throughout common areas of the facility. Bathrooms had soap and paper towels. Hygiene items were available. The facility was well-stocked with activities for the clients.

Facility has at least a 30 day supply of Incontinence, medication and personal protective equipment (PPE) including but not limited to masks, gowns, and hand sanitizer. Smoke and carbon monoxide detectors were tested and appeared to be working. Fire extinguisher was last serviced 6/27/2023.

No deficiencies found at the time of inspection. No citations issued. .
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2023
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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