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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496802043
Report Date: 04/18/2023
Date Signed: 04/18/2023 03:54:08 PM

Document Has Been Signed on 04/18/2023 03:54 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:
04/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Program Director, Racquel Raval
Administrator, Elizabeth Pickering		TIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Progress Sonoma for the purpose of conducting a Required 1 year inspection. LPA was greeted at the front door by Program Director, Racquel Raval and was granted access into the facility. Administrator, Elizabeth Pickering arrived 30 minutes later.

LPA and Program Director toured the facility. LPA observed the facility to be clean and at a comfortable temperature with all exits free from obstruction. However, during the tour of the facility, LPA observed no Emergency Generator on site. LPA learned that the facility is in the process of obtaining an Emergency Generator (See LIC 9102). Fire Extinguisher was found to be last charged on January 2023 at the time of the inspection. All smoke detectors and carbon monoxide detectors were tested and found to be operational during the inspection. Water temperature in clients bathroom measured at 107 degrees in 3 out of 3 clients bathrooms and is within acceptable range of 105 to 120 degrees F. There was sufficient perishable and non-perishable foods located in the kitchen. There are special provisions made for individuals with special dietary needs. Food menu was presently available for viewing during the inspection. Medications were centrally stored and locked. Medication Assessment Records (MARS) were reviewed during the inspection and were found to be appropriate. Cleaning products and other toxins are locked and inaccessible to clients in care. There was a supply of Linens, cleaners, hygiene products and paper products available for clients. All bathrooms designated for clients in the common areas at the facility were supplied with individual paper towels and hand soap. Bathrooms in resident’s rooms have a towel and soap. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. A tour of all clients bedrooms were conducted, and bedrooms inspected have lighting and appropriate furnishing.

LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Facility has PPE which is stored and staff was donning face masks during the Required 1 year inspection. (Report continued on LIC 809C)
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2023
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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: PROGRESS SONOMA
FACILITY NUMBER: 496802043
VISIT DATE: 04/18/2023
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LPA conducted staff interviews with five (6) staff members. LPA interviewed a sample population of the clientele in care. LPA reviewed client files during the Required 1 year inspection and found client files to be appropriate during the inspection. Staff records were reviewed during the Required 1 year inspection and also found to be appropriate. In addition, ALL staff members had a active First Aid/CPR cards out and for review during the inspection. First Aid kit was inspected and found to be appropriate during the inspection.

LPA requested the following documents to be sent:

LIC 500- Personnel Report
LIC 308- Designation of Responsibility
LIC 309- Administrative Organization
LIC 400- Affidavit regarding Client Cash Resources
Updated facility sketch
Updated Emergency Disaster Plan (LIC 610)
Surety Bond
Most up-to-date Liability insurance
Control of Property
Register of residents
Fire Alarm System Inspection Test

No deficiencies were cited during today's Required 1 year inspection. Exit interview was conducted and a copy of this report was given to the Program Director.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023
LIC809 (FAS) - (06/04)
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