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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801563
Report Date: 12/19/2022
Date Signed: 12/19/2022 11:25:49 AM

Document Has Been Signed on 12/19/2022 11:25 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:BECOMING INDEPENDENT-SANTA ROSAFACILITY NUMBER:
496801563
ADMINISTRATOR:COX, JAMESFACILITY TYPE:
775
ADDRESS:1455 CORPORATE CENTER PKWY.TELEPHONE:
(707) 524-6600
CITY:SANTA ROSASTATE: CAZIP CODE:
95407
CAPACITY: 285CENSUS: 0DATE:
12/19/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:James Cox (Administrator) TIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Cuadra arrived announced to conduct a Case Management inspection and met with James Cox (Administrator). There are no participants at the time of visit. On 5/28/21 Facility notified CCL about their intentions to start a major renovation project of their Santa Rosa site. Facility has completed the rebuild and is wanting to re-open. Santa Rosa Fire Department approved the fire clearance for 107 non-ambulatory and 178 ambulatory for a total capacity of 285 participants effective 12/13/22. The day program is open Monday through Friday from 8:00am to 4:00pm.

LPA/Administrator initiated a tour of the building and grounds at approximately 10:33am and made the following observations: The campus is a building housing some administration offices, changing rooms, lunchroom, wellness room, fitness room, multiple areas used for activities and staging areas for participants who go out into the community. Facility was a comfortable temperature and passageways were free from obstructions. Bathrooms used by participants were sanitary and in good repair. Water temperature in bathrooms used by participants read at 117 which are within regulation of 105 and 120 degrees F. Toxins will be located in a janitorial closet which will be kept locked. In the hallway near the kitchen there are designated lockers for participants to store their items. Knives and other items that could pose a risk were locked. Participants bring their own lunch and those who stay at the facility during the day eat in the lunchroom or in common areas. Refrigerators for participant lunches were clean. Medication is centrally stored and locked in the support team office. Fire extinguisher was last inspected April 2022. Facility smoke alarms and carbon monoxide detectors are hard wired and inspected and maintained by a vendor. Most recent inspection from the local fire department was conducted 11/21/2022. Facility provides transportation for some participants. Facility van contains a first aid kit and fire extinguisher was charged and serviced. First aid kit is fully stocked. Required postings were observed. Administrator submitted their updated emergency plan of the facility, including the Covid19 pandemic policies. Re-admission of the facility participants is approved today, 12/19/22.
No deficiencies cited during this inspection.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2022
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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