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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490102164
Report Date: 01/15/2025
Date Signed: 01/15/2025 11:10:20 AM

Document Has Been Signed on 01/15/2025 11:10 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:SEBASTOPOL DAY SERVICESFACILITY NUMBER:
490102164
ADMINISTRATOR/
DIRECTOR:		DUFFY, REBECCA JFACILITY TYPE:
775
ADDRESS:167 NORTH HIGH STREETTELEPHONE:
(707) 525-0143
CITY:SEBASTOPOLSTATE: CAZIP CODE:
95472
CAPACITY: 30CENSUS: 8DATE:
01/15/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:44 AM
MET WITH:Mary "Pat" Coleman (Site Coordinator)TIME VISIT/
INSPECTION COMPLETED:
11:25 AM
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Licensing Program Analyst (LPA) Cuadra, arrived unannounced to conduct an Annual Required Inspection and met with Site Coordinator, Mary "Pat" Coleman. The program is open to participants Mondays and Wednesdays from 9:30 am to 2:00 pm. Required postings were observed. Contact information reviewed.

LPA initiated a tour of the facility at 9:30 am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Seven participants were sitting at a table and were engage in activities like music at the time of visit. The activity schedule for the day was written on a white board. The day program operates out of a primary room within the Sebastopol Senior Center and participants have the option of eating at the on-site dinning area. Meals are provided by Meals on Wheels. There are 2 common bathrooms available for participant use and exterior space. Water temperature in bathroom measured at 105.2 degrees F which is not within allowable range of 105 to 120 degrees F. Bathrooms were equipped with grab bars to ensure safety. Toxins were inaccessible. Facility does not handle cash resources or medications for day program participants and does not provide transportation. Fire extinguisher was last inspected September, 2024. The smoke alarm system and fire extinguishers are maintained by the Sebastopol Senior Center. The smoke alarm system is maintained by a vendor and the most recent test was completed in September, 2024. Most recent disaster drill was conducted 1/15/2025. Carbon monoxide was operational. Annual fees current.

LPA initiated file review at 10:00am. Two staff files and eight participant files were reviewed. Staff have required First Aid/CPR certificates and annual training hours. Participant's plan of cares and medical assessments were current.

Site Coordinator agreed to submit updates of the following documents by 1/24/2025: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500) and Lease agreement.

No deficiencies cited during today's visit. Exit interview conducted with Site Coordinator and copy of this report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/15/2025
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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