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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496800353
Report Date: 09/01/2022
Date Signed: 09/01/2022 11:52:01 AM

Document Has Been Signed on 09/01/2022 11:52 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:FAIRWAY PLACEFACILITY NUMBER:
496800353
ADMINISTRATOR:FRYE, JANEFACILITY TYPE:
735
ADDRESS:4796 FAIRWAY DRIVETELEPHONE:
(707) 588-2788
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 6CENSUS: 6DATE:
09/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jane Frye-AdministratorTIME COMPLETED:
11:55 AM
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 Analysts (LPA) Alviso arrived to conduct a Required-1 Year inspection and met with Licensee/Administrator Jane Frye The inspection is focused on the Infection Control procedures and practices of this facility.

The Licensee/Administrator has submitted the Infection Control Plan as required. Fire clearance is approved for six (6) ambulatory. There are six (6) clients in care at the facility; One(1) client was home, and the other five(5) clients were out, some were at school, at day program, and others at work. Clients are screened daily, observed for any changes, and all information is logged. All visitors, and staff are screened before entry; Temperatures are taken, and screening questions are asked of all before being allowed into the facility. All screening information is logged as required. The LPA was screened before the Administrator allowed LPA entry into the facility. The screening was logged.

Fire extinguishers were current as required, serviced and tagged, 7/1/2022. Smoke alarms, are hard wired; The fire system's annual inspection check, completed by a professional service company, was completed and passed on 10/7/2021. There are additional smoke alarms throughout the facility as well as carbon monoxide detectors, approximately ten(10) of each, one in every room.
Food supply was sufficient, and the LPA had observed the Administrator arrive to the facility with additional groceries that had just been purchased for the facility. Facility was found to be clean, orderly, and at a comfortable temperature with exits free from obstruction. Toxins are stored in locked cabinets. Medications are locked up and inaccessible to clients in care. There was a sufficient supply of hygiene products, disinfectant cleaners, and paper products for use as needed. All postings were up and visible to all as required. Facility has a sufficient supply of personal protective equipment(PPE). Appropriate PPE items are available for use by staff, clients, and visitors as needed and required. LPA observed the Administrator with a mask on upon Administrator's arrival to the facility and throughout the facility inspection.

No deficiencies found in the areas inspected.
Exit interview conducted with the Administrator.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2022
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