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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803260
Report Date: 10/03/2023
Date Signed: 10/03/2023 01:18:19 PM


Document Has Been Signed on 10/03/2023 01:18 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:RYAN HOUSEFACILITY NUMBER:
496803260
ADMINISTRATOR:GAUSE, LIYAN ZHANGFACILITY TYPE:
735
ADDRESS:4033 PRINCETON DRIVETELEPHONE:
(707) 578-5707
CITY:SANTA ROSASTATE: CAZIP CODE:
95405
CAPACITY:3CENSUS: 0DATE:
10/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Ralph GauseTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA), Farhaan Sarangi arrived at Ryan House for the purpose of conducting a Required 1 year inspection. LPA was greeted at the door by Administrator, Ralph Gause, and was granted access into the facility. Currently there is 0 clients in placement at this time. Facility is still remodeling in preparation for NBRC clientele.

LPA toured the facility and observed the facility to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguishers were found to be last charged on December 2022 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 1 of 1 residents bathroom measured at 105 degrees and is within acceptable range of 105 to 120 degrees F. Sufficient food was observed. A place for medications that can be locked was observed during the inspection. Cleaning products and other toxins are located in the locked laundry room and inaccessible to clients in care. Facility is furnished and ready for client placement. Licensee is currently in the process of updating there Emergency Disaster Plan and Infection Control Plan (See LIC 9102's-Technical Violations) in preparation for client placement. Licensee and the Administrator is in the process of conducting training's. LPA requested the following documents:

LIC 500-Personnel Report
Updated Infection Control Plan
Updated Emergency Disaster Plan
LIC 308-Designation of Responsibility
Liability insurance
Control of Property
Administrators Certificates once received
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 Administrator..
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5029
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: 707-588-5034
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2023
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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