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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496802043
Report Date: 03/10/2022
Date Signed: 03/10/2022 03:05:40 PM

Document Has Been Signed on 03/10/2022 03:05 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:PROGRESS SONOMAFACILITY NUMBER:
496802043
ADMINISTRATOR:ELIZABETH PICKERINGFACILITY TYPE:
772
ADDRESS:3400 MONTGOMERY DRIVETELEPHONE:
(707) 526-6902
CITY:SANTA ROSASTATE: CAZIP CODE:
95405
CAPACITY: 10CENSUS: 9DATE:
03/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Racquel Raval (Assistant Director)TIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Erik Gonzalez Campos arrived unannounced at approximately 1:30 PM on 03/10/2022 to conduct a Required 1-Year Inspection. LPA was initially greeted by staff and asked to answer screening questions, take temperature and sign in. Assistant Director Racquel Raval arrived shortly. This inspection was focused on the infection control practices and procedures of this facility.

Facility is a short term social rehabilitation facility with 9 clients currently in care. Facility has testing procedures in place for admitting new clients. All staff have been vaccinated with their booster shot. Facility has submitted a COVID mitigation plan to community care licensing.

LPA toured facility with assistant director. COVID postings were observed at the front entrance. Client bedrooms were observed furnished per regulations. Extra linen and hygiene products were available for clients. Toxins were observed locked and inaccessible to clients. Knives were in a locked drawer. Sufficient perishable and non-perishable food was observed. Medications are locked and stored in administrative office. Staff have received training on Personal Protective Equipment (PPE) use but have not been N95 fit tested. Clients are screened and monitored at least once day. Surfaces disinfected daily.

There are 5 client bedrooms with 2 clients per bedroom. There is space available to isolate a client if necessary as well as plans to move clients to an alternative care site if necessary.

LPA requested the following documents during the visit: Personnel Report, Designation of Facility Responsibility, and Emergency Disaster Plan to be submitted by 3/18/2022

Exit interview conducted with assistant director and a copy of this report was printed for the facility.

No deficiencies cited during today's inspection.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Erik Gonzalez Campos
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2022
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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