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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803398
Report Date: 02/14/2024
Date Signed: 02/14/2024 01:30:55 PM

Document Has Been Signed on 02/14/2024 01:30 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 FOUNDATION-PARKER HILL PLACEFACILITY NUMBER:
496803398
ADMINISTRATOR:VIEIRA-TAYLOR, JANEENFACILITY TYPE:
772
ADDRESS:3371 PARKER HILL ROADTELEPHONE:
(707) 535-0289
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY: 12CENSUS: 11DATE:
02/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Matthew (Matt) Long-Program DirectorTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 2/14/24 at approximately 9:20am, and met with Program Director Matthew Long, and Senna Wolter, Assistant Director. There are currently eleven (11) residents in care.

Facility has an infection control plan as required. The facility has a required emergency disaster plan. Fire clearance is approved for twelve (12) ambulatory residents. The facility is conducting fire and emergency drills as required, per review of binder of drills.The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements.

LPA reviewed six (6) client files; All files were complete.

The LPA reviewed six (6) staff files. All staff had required criminal record clearance. All staff had first aid and cpr certification as required. All staff had required training.

LPA toured the facility with the Program Director. All exits were clear and unobstructed. All three (3) fire extinguishers were serviced and tagged. Fire Department inspected and cleared the fire alarm system 8/19/23, this expires July 2024. Food supply was sufficient. Sufficient lighting throughout the facility. Furnishings were observed in sufficient supply for resident use.

Medications were locked up and inaccessible to clients in care. Cleaners and toxins were locked up and inaccessible to clients in care. Sufficient supply of hygiene products were observed. Sufficient supply of linens and towels for resident use.

Continued on LIC809C...
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2024
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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Document Has Been Signed on 02/14/2024 01:30 PM - It Cannot Be Edited


Created By: Dina Alviso On 02/14/2024 at 11:46 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: PROGRESS FOUNDATION-PARKER HILL PLACE
FACILITY NUMBER: 496803398

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
81088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation of the hot water temperature in two resident bathrooms were checked at 130.F which is -not within regulation of no lower than 105. F and not above 120.F, the licensee did not comply with the section cited above in [2] out of [3t) resident bathrooms, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/15/2024
Plan of Correction
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Licensee to ensure the facility turns down the hot water heater, and that hot water is monitored to ensure that it is witthin regulation of 105. degrees Fahrenheit to not over 120. degrees Fahrenheit. Submit plan of ensuring compliance with this regulation by 2/15/24, and that you will log the water for a period of one week. Follow-up with hot water log by 2/22/24. POC due 2/15/24.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Carla Martinez
LICENSING EVALUATOR NAME:Dina Alviso
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2024


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 FOUNDATION-PARKER HILL PLACE
FACILITY NUMBER: 496803398
VISIT DATE: 02/14/2024
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LPA requested the following documents to be updated and submitted by 3/14/2024:

LIC 500- Personnel Report
LIC 308- Designation of Responsibility
LIC 400- Affidavit regarding Client Cash Resources
Copy of Surety Bond
Updated Emergency Disaster Plan (LIC 610D)
Updated Infection Control Plan
Copy of Liability insurance
Register of residents

The hot water temperature in two resident bathrooms were at 130.F when LPA checked them, the facility runs off two hot water heaters. This deficiency will be cited, 81088(e)(1)- Fixtures, Furniture, Equipment, and Supplies, Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C), see LIC809D.


Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.

Appeal rights provided to the Program Director, Matthew Long.

Exit interview conducted.

SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024
LIC809 (FAS) - (06/04)
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