<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490107871
Report Date: 10/15/2024
Date Signed: 10/15/2024 04:46:52 PM

Document Has Been Signed on 10/15/2024 04:46 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:
10/15/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:05 PM
MET WITH:Nancy Brasher- Lead Caregiver (DSP)TIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Alviso arrived unannounced to conduct a Required -1 Year inspection, on 10/15/2024 at approximately 2:00pm, and met with Lead caregiver, Nancy Brasher.

There are four (4) clients in care. Three (3) clients were at day program, and one (1) client was home during the inspection.

The LPA reviewed four (4) client files. All files were complete. P&I funds were accounted for, and maintained in compliance with regulations.

The LPA reviewed three (3) staff files. All staff had required criminal record clearance, current certification in first aid, and CPR.

The LPA reviewed records of facility emergency disaster drills, last drill was held on 6/12/24.

Hot water was checked at 115.5 degrees Fahrenheit. 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.

No deficiencies were cited during today's inspection.
Exit interview was held with Lead Caregiver Nancy Brasher.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024
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 1