496801563-7-9-2026-21-AS-MCUA-DRNQEY-20260226110708

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 496801563
Report Date: 02/26/2026
Date Signed: 07/09/2026 11:15:49 AM

Document Has Been Signed on 07/09/2026 11:15 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 ROSA		FACILITY NUMBER:	496801563
ADMINISTRATOR/ DIRECTOR:	VAETOE, LUANA		FACILITY TYPE:	775
ADDRESS:	1455 CORPORATE CENTER PKWY.		TELEPHONE:	(707) 524-6600
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95407
CAPACITY: 285		CENSUS: 29	DATE:	02/26/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:47 AM
MET WITH:	Stephanie Rodriguez (Service Director)		TIME VISIT/ INSPECTION COMPLETED:	11:27 AM

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	***Amended... LPA Cuadra returned to the facility unannounced to amend this annual visit. The document requires amending because the annual needs to reflect additional civil penalties language under Health & Safety [H&S1548(B)(ii)] [not (f)] which was documented in error by LPA and the amended document deletes reference to H&S1569.49 (f). LPA removed the language in LIC809C as well. Report was amended and signed today, 7/9/2026.Licensing Program Analyst, (LPA) Cuadra arrived unannounced to conduct an Annual Required inspection met with Service Director, Stephanie Rodriguez and Director of Quality, Matt Flores. The day program is open Monday through Friday from 8:00am to 4:00pm. The facility is a community based program, there are currently 29 participants on-site and 122 participants are out in the community. 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 105.7, 106.7, 106.7 and 106.3 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 7/2025. Facility smoke alarms and carbon monoxide detectors are hard wired and inspected and maintained by a vendor. Continued on LIC809C...

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Marisol Cuadra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/09/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: BECOMING INDEPENDENT-SANTA ROSA	FACILITY NUMBER: 496801563
	VISIT DATE: 02/26/2026

NARRATIVE

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Continued from LIC809...

Most recent inspection was conducted on 10/15/25 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 12/30/25. LPA initiated file review at 9:30 am, six staff and ten participant files were reviewed. Staff have required First Aid and CPR training and required annual training hours. Two out of ten participants medical assessment needs to be updated (technical violation issued). Required postings were observed. The facility doesn't handle cash resources. Annual fees current.

During today’s visit, LPA is following up on an office visit conducted on 1/7/26, where concerns that have been identified by the licensing agency regarding substantiated findings of incident report – priority 2 investigation conducted by the department due to the facility failed to provide safety and adequate supervision to a client (C1) resulting in a report of client being sexually abused. Previously, the Administrator stated that they have implemented preventive measures to ensure safety and adequate supervision of clients in care including rotating staff schedules, staff meetings and in-service training was conducted with all staff. Today, LPA was provided with staff schedule rotation, staff training records and updated policy. The Service Director was informed that additional civil penalties are under review by the Department per Health and Safety Code 1548(B)(ii).

Facility provided updated copies of the following documents: Personnel Report (LIC500).

No deficiencies cited during this inspection. Exit interview conducted with Service Director and a copy of this report was given.

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Marisol Cuadra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/09/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026

LIC809 (FAS) - (06/04)

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