<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801563
Report Date: 03/04/2025
Date Signed: 03/04/2025 12:02:53 PM

Document Has Been Signed on 03/04/2025 12:02 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:BECOMING INDEPENDENT-SANTA ROSAFACILITY NUMBER:
496801563
ADMINISTRATOR/
DIRECTOR:		FINLEY, PAULAFACILITY TYPE:
775
ADDRESS:1455 CORPORATE CENTER PKWY.TELEPHONE:
(707) 524-6600
CITY:SANTA ROSASTATE: CAZIP CODE:
95407
CAPACITY: 285CENSUS: 33DATE:
03/04/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Stephanie Rodriguez (Service Director)TIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts, (LPAs) Cuadra and Contreras arrived unannounced to conduct an Annual Required inspection and met with Service Director, Stephanie Rodriguez. The day program is open Monday through Friday from 8:00am to 4:00pm. Required postings were observed.

LPA/staff initiated a tour of the buildings and grounds at approximately 9:00 am and made the following observations: 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 104,106.3,108, and 114.2 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. The facility does not handle medications. Fire extinguisher was last inspected 7/2024. Facility smoke alarms and carbon monoxide detectors are hard wired and inspected and maintained by a vendor. Most recent inspection was conducted on 12/09/24 from Major Alarm vendor. 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. Last disaster drill was conducted on 12/09/24.

LPA initiated file review at 10:00 am, five staff and ten participant files were reviewed. Staff have required First Aid and CPR training. Participants records are updated. The facility doesn't handle cash resources.
continued on LIC809C...
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Ethel Contreras
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: BECOMING INDEPENDENT-SANTA ROSA
FACILITY NUMBER: 496801563
VISIT DATE: 03/04/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued from LIC809...
During today's visit, LPAs followed up on SOC341 received at Community Care Licensing (CCL) on 2/10/25. Per SOC341, on the morning of 2/5/25, the Service Director met with participant (P1) and their responsible party to discuss concerns regarding incontinence care services been provided to P1 at the facility. However during this meeting P1 mentioned an incident that happened in the previous night, in which their parent was attempting to provide assistance with incontinence care and P1 physically resisted described as a mutual disagreement. At the end of the day, Service Director checked back with P1, additional information regarding the incident was obtained, where it was disclosed by P1 that they did not feel safe at home and was afraid of what might happen that night. P1 expressed that when their parent was attempting to change them, their parent hit them in the face and kicked them in the legs twice. Upon a physical assessment, no injuries were visible and no injuries or pain were reported by P1. The facility followed up protocol by notifying pertinent parties including CCL. LPA was provided with police records #SR25-1495 where it was determined that the incident was mutual and P1 would be safe to return home. P1 is currently in a community based program with the facility and they were not present during this visit. No further incidents have been reported by P1.

Facility will provide updated copies of the following documents by 3/25/25: Designation of Responsibility (LIC308) and Personnel Report (LIC500).

No deficiencies cited during this inspection. Exit interview conducted with Service Director and a copy of this report was given.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Ethel Contreras
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
LIC809 (FAS) - (06/04)
Page: 2 of 2