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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490109865
Report Date: 05/16/2024
Date Signed: 05/16/2024 02:36:11 PM

Document Has Been Signed on 05/16/2024 02:36 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:STEPHEN'S HOUSEFACILITY NUMBER:
490109865
ADMINISTRATOR/
DIRECTOR:
LA DOW, JEFFFACILITY TYPE:
735
ADDRESS:2420 GARDNERTELEPHONE:
(707) 542-0506
CITY:SANTA ROSASTATE: CAZIP CODE:
95407
CAPACITY: 6CENSUS: 4DATE:
05/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Jeff LaDow (Licensee/Administrator)TIME VISIT/
INSPECTION COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required Inspection and met with Licensee/Administrator Jeff LaDow who arrived later. Clients were attending day program during visit. LPA had technical issues with laptop's battery.

LPA/Licensee initiated a tour of the facility and made the following observations: Facility was a comfortable temperature and pathways were free from obstructions. Client rooms are furnished per regulation. Water temperatures in client bathrooms read at 109.6 and 107.8 which are within regulation of 105 and 120 degrees F. At least two days of perishable and one week of non-perishable foods were available. Toxins are locked in a cabinet in the garage. Medications are centrally stored in locked boxes. Required postings were observed.

Fire extinguishers were last inspected April 2024. Facility has a fire pull system. Smoke detectors and carbon monoxide detector located throughout the facility were tested and operational. Most recent Fire/Disaster drill was conducted 2/8/2024. Cash resources and documentation were reviewed.

LPA initiated a file review at 2:00 pm. Four client and three staff files were reviewed. First aid certificates for staff are current. Administrator Certificate for Jeff LaDow 6014982735, expired 4/12/2024 and have proof of submission to the Administrator certification unit. Medications and medication records were reviewed.

Licensee provided the following documents - Copy of Surety Bond, LIC308 - Designation of Administrative Responsibility, LIC500 Personnel Report and LIC610D - Emergency Disaster Plan.
No deficiencies cited during this inspection. Exit interview conducted with Licensee and a copy of this report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2024
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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