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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801251
Report Date: 02/19/2025
Date Signed: 02/19/2025 02:24:30 PM

Document Has Been Signed on 02/19/2025 02:24 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:OLDS HOMEFACILITY NUMBER:
496801251
ADMINISTRATOR/
DIRECTOR:		OLDS, CATHERINEFACILITY TYPE:
735
ADDRESS:936 LANGEBURG ST.TELEPHONE:
(707) 526-4884
CITY:SANTA ROSASTATE: CAZIP CODE:
95407
CAPACITY: 4CENSUS: 4DATE:
02/19/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Cathy Olds (Licensee)TIME VISIT/
INSPECTION COMPLETED:
02:39 PM
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Licensing Program Analyst (LPA) Cuadra, arrived unannounced to conduct an Annual Required Inspection and met with Licensees Cathy Olds and Dave Olds. Annual fees are current.

LPA initiated a tour of the facility at 1:00 pm 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's bathroom measured at 115 degrees F which are within allowable range of 105 to 120 degrees F. Extra hygiene products and linens were available. Cabinets containing cleaning supplies was locked. Facility has at least two days of perishable and one week of non-perishable foods. Medications are maintained centrally stored and locked. Last disaster drill conducted on February 9, 2025. Fire extinguisher was last inspected 9/2024. Smoke detectors located throughout the facility were tested and operational. Carbon monoxide detector was tested and operational. Evacuation chair located in the office. Contact information was reviewed.

File review was initiated at 1:30 pm. Two staff files and four client files were reviewed. Staff have required First Aid certificates. Administrator Certificate for Licensee Catherine E. Olds #6020256735, expires 11/8/2025. Cash resources and documents were reviewed.

Licensee/Administrator to submit updates of the following documents by 2/28/2025: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500) and Surety Bond.

No deficiencies cited during this inspection. Exit interview conducted with Licensees and copy of this report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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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