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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801313
Report Date: 03/28/2022
Date Signed: 03/28/2022 03:10:52 PM

Document Has Been Signed on 03/28/2022 03:10 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:SARAH'S YOUNG ADULT HOMEFACILITY NUMBER:
496801313
ADMINISTRATOR:GREGORI, LINDSEYFACILITY TYPE:
735
ADDRESS:1520 GRIFFIN WAYTELEPHONE:
(707) 585-6223
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 6CENSUS: 4DATE:
03/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Lindsey Gregori-AdministratorTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Dina Alviso arrived to conduct a Required 1-Year inspection, and met with Administrator Lindsey Gregori. The inspection is focused on the Infection Control procedures and practices of this facility.

There is a fire clearance approval for ambulatory only. Mitigation plan was reviewed by the Department There are four(4)clients in care, all were attending day program during this inspection. All visitors, essential visitors, and staff are screened upon entry; Temperatures are taken, and screening questions are to be answered before being allowed to remain in the facility, all information is logged. Clients are screened daily, and observed for any changes, all information is logged.

Facility was found to be clean, orderly, and at a comfortable temperature with exits free from obstruction. Toxins are stored in locked cabinets. There was a sufficient supply of hygiene products, cleaners, and paper products for use as needed. Medications are stored locked making them inaccessible to clients in care. All postings were up and visible to all as required. Facility has a sufficient supply of personal protective equipment(PPE). Administrator had a mask on during the LPA's inspection.

No deficiencies found in the areas inspected.
No citations issued.
Exit interview conducted with the Administrator.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2022
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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