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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496800668
Report Date: 08/14/2023
Date Signed: 08/14/2023 09:50:16 AM

Document Has Been Signed on 08/14/2023 09:50 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:SARAH'S ADULT RESIDENTIAL CAREFACILITY NUMBER:
496800668
ADMINISTRATOR:GREGORI, LINDSEYFACILITY TYPE:
735
ADDRESS:3030 TERRA LINDA DRIVETELEPHONE:
(707) 527-8990
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY: 6CENSUS: 2DATE:
08/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Staff, Alma Gonzalez FragosoTIME COMPLETED:
10:00 AM
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Licensing Program Analysts Bertozzi and Rummonds arrived unannounced to conduct and Annual Required inspection and met with Staff, Alma Gonzalez. Administrator, Lindsey Gregori was unable to come to facility but was available by phone.

LPAs initiated a tour of the facility around 9:55am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Client rooms were furnished per regulation. Water temperature in client bathrooms measured at 111 and 113 degrees F which is within the range of 105 to 120 degrees F allowed per regulation. Extra hygiene products and linens were available. Kitchen cabinet containing cleaning supplies was locked.

Fire extinguisher was last serviced November 2021.

LPAs were unable to complete inspection and will return at a later time.

No deficiencies cited during this visit,
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2023
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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