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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496800764
Report Date: 07/30/2024
Date Signed: 07/30/2024 10:53:06 AM

Document Has Been Signed on 07/30/2024 10:53 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:KENNEMER HOME-ROHNERT PARKFACILITY NUMBER:
496800764
ADMINISTRATOR/
DIRECTOR:
ROONEY, MARGOFACILITY TYPE:
735
ADDRESS:7527 BORIS COURTTELEPHONE:
(707) 795-3706
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 6CENSUS: 4DATE:
07/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Margo Rooney, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Hansen arrived unannounced to conduct an annual inspection on 7/30/24 at approximately 8:00 am, and was met by Shawn Rooney, caregiver. The Administrator was contacted by staff to notify of LPA's arrival. The Administrator arrived shortly after. Currently there are four clients in care. All clients had been picked up by day program transportation.

At approximately 8:10 AM, LPA and Administrator toured the buildings and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be clear and unobstructed. Hot water checked, measured at 119.4 degrees F which is within regulations of between 105 degrees F and 120 degrees F. LPA observed a sufficient supply of food. The LPA observed a sufficient supply of cleaners, hygiene products, and paper products. Medications are locked up in backyard office in locked cabinet making them inaccessible to clients in care. Cleaners/toxins were locked, making them inaccessible to clients in care. LPA observed a sufficient supply of linen for client use. The facility has sufficient furnishings for clients use. The large backyard has a soundproof music room shed for client use; There is a pool located in the backyard which was observed locked. Facility has a small office in the backyard. The facility was clean and orderly, including the backyard area.

At approximately 9:10 AM, LPA reviewed 4 of 4 Client records and 4 of 4 Staff records, which were all found to be well organized, thorough, and contained the required documentation. First Aid and CPR certification were current in staff files reviewed. P&I monies were documented, secure and not commingled. Administrator’s Certificate for Margo Rooney was current with an expiration date of 3/31/2026.

Smoke alarms were working properly when checked during the inspection two of which are also carbon monoxide detectors. Fire extinguishers, three (3) were all serviced on 7/26/2024. Interviews conducted with staff. Disaster drills are conducted monthly with the last drill conducted 7/6/2024.
Continue on LIC809-C
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
LICENSING EVALUATOR SIGNATURE: DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: KENNEMER HOME-ROHNERT PARK
FACILITY NUMBER: 496800764
VISIT DATE: 07/30/2024
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There are no deficiencies cited today.

LPA requested the following forms to be updated and submitted to CCL by 8/25/24:

LIC 500-Personnel Report
LIC 9020 Client list
Affidavit Regarding Client Cash Resources
Copy of Surety Bond
Emergency Disaster Plan (if changes)
Administrator Certificate

Exit interview conducted with Licensee/ Administrator
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
LIC809 (FAS) - (06/04)
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