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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801929
Report Date: 12/11/2020
Date Signed: 12/11/2020 03:45:58 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:FRIENDS HOUSEFACILITY NUMBER:
496801929
ADMINISTRATOR:ALLEN, CLARAFACILITY TYPE:
741
ADDRESS:684 BENICIA DRIVETELEPHONE:
(707) 538-0152
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY:120CENSUS: 5DATE:
12/11/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Clara Allen, Executive DirectorTIME COMPLETED:
02:21 PM
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Licensing Program Analyst (LPA) Mota conducted a case management inspection regarding a request for a capacity increase. The facility has requested to increase their capacity from 80 non ambulatory to 105 non ambulatory, 7 of which may be bedridden. LPA met with Clara Allen, Executive Director and Bill Faulkner, Maintenance Technician via Zoom due to COVID-19 precautions. The inspection is being conducted by tele-video inspection due to COVID-19. The reader is advised that the LPA did not physically make a site visit. The purpose of the inspection was to inspect the prior skilled nursing area that was converted to the assisted living (AL) section of the facility. The current AL area will no longer be utilized by AL.

Facility had submitted an updated LIC200 showing the increase in capacity along with a revised faiclity sketch. A fire clearance was completed and approved to increase the non-ambulatory capacity from 80 residents to 105 residents (7 of which may be bedridden) on 11/30/2020. A random inspection of a fire extinguisher showed it was last charged on 4/30/2020.

LPA observed the following during the tele-visit: All rooms were equipped with a pull string call system that illuminates a light outside the resident room and alerts a main control panel. Each room had closet space, a sink and a separate bathroom area. The facility will utilize one main shower room for resident bathing needs. All areas appeared to be equipped with proper grab bars.

A large common area was observed with a piano where residents will engage in social activities. A dining area was observed. Meals will be prepared in the main kitchen area where the facility also prepares meals for the Independent Living (IL) residents.

Continued on 809-C
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5079
LICENSING EVALUATOR NAME: Kimberley MotaTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: FRIENDS HOUSE
FACILITY NUMBER: 496801929
VISIT DATE: 12/11/2020
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LPA observed a locked office that will store medications as well as an office that is designated for the Resident Services Coordinator and will serve as a private meeting area.

Currently there is no furniture or residents in the renovated area. Executive Director informed LPA that furniture is scheduled to arrive in January or February of 2021. Residents located in the current Assisted Living (AL) portion of the facility will be moving their items approximately 12/29/20.



No deficiencies were cited during the visit
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5079
LICENSING EVALUATOR NAME: Kimberley MotaTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2020
LIC809 (FAS) - (06/04)
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