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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490107871
Report Date: 10/09/2024
Date Signed: 10/09/2024 05:32:28 PM

Document Has Been Signed on 10/09/2024 05:32 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:SARAH'S GROUP HOME FOR YOUNG ADULTSFACILITY NUMBER:
490107871
ADMINISTRATOR/
DIRECTOR:		LAWRENCE, SARAHFACILITY TYPE:
735
ADDRESS:8019 ADRIAN DRIVETELEPHONE:
(707) 795-9701
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 6CENSUS: 4DATE:
10/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:40 PM
MET WITH:Nancy Brasher- Caregiver (DSP)TIME VISIT/
INSPECTION COMPLETED:
05:40 PM
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Licensing Program Analyst (LPA) Alviso arrived unannounced to conduct a Required -1 Year inspection, on 10/9/2024 at approximately 3:40pm, and met with caregiver, Nancy Brasher. Currently there are four (4) clients in care.

The facility has a fire clearance for six (6) ambulatory clients. The hospice waiver is no longer in effect, as this was for a specific client that passed at the end of 2015. If the Licensee wants to reapply for a hospice waiver, they can per the regulations, and will have to obtain a non-ambulatory fire clearance approval. Licensee may contact the LPA for more information if needed. The LPA will send the Licensee an updated license, reflecting updated license comments.

Fire extinguishers were serviced and tagged as required, dated 7/11/24 Facility has a required carbon monoxide detector. The facility has required smoke alarms. Facility was observed to be clean and orderly. The food supply was observed to be sufficient. All medications were locked up and inaccessible to the clients in care. Disinfectants/cleaners were observed to be locked up and inaccessible to clients in care. Hygiene products, paper products, and linens were observed to be a sufficient supply for clients in care.

The LPA will continue the annual inspection at a later date.

No deficiencies cited today.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2024
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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