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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803398
Report Date: 02/16/2023
Date Signed: 02/16/2023 01:48:38 PM

Document Has Been Signed on 02/16/2023 01:48 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:PROGRESS FOUNDATION-PARKER HILL PLACEFACILITY NUMBER:
496803398
ADMINISTRATOR:LONG, MATTHEWFACILITY TYPE:
772
ADDRESS:3371 PARKER HILL ROADTELEPHONE:
(707) 535-0289
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY: 12CENSUS: 10DATE:
02/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Backup Administrator, Matthew LongTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Victoria Bertozzi arrived unannounced, to conduct an Annual Required inspection and met with Backup Administrator, Matthew Long. The inspection is focused on the Infection Control procedures and practices of this facility.

Upon arrival, LPA observed Covid-19 posters on the front door including a poster indicating no visitors were permitted. Discussion with Backup Administrator indicated the facility is allowing visitors and the poster will be removed. LPA initiated a walk-through of the facility around 1:10pm and observed the following: Facility has COVID-19 posters throughout that include hand washing signs in bathrooms. Facility was a comfortable temperature and exits were free from obstructions. Hand sanitizer is located throughout common areas of the facility. Commonly touched surfaces are disinfected three time per day.

Facility has a designated visitation area outside and is allowing for visitation inside per CCL guidance. Staff continue to receive education on infection control and Personal Protective Equipment.

Facility has at least a 30 day supply of PPE including but not limited to masks, gloves, and hand sanitizer. Facility maintains a 30 day supply of medication. Fire extinguishers were last serviced December 2022. The local fire department conducted an inspection recently and no issues were noted. Carbon monoxide detector was tested and operational.

Administrator to submit updates of the following documents by 03/16/2023:



LIC 500 Personnel Summary
LIC 610 Emergency Disaster Plan (if changes)
Updated Infection Control Plan (if changes)

No deficiencies cited during this inspection.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023
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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