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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803583
Report Date: 11/15/2021
Date Signed: 11/15/2021 11:20:40 AM

Document Has Been Signed on 11/15/2021 11:20 AM - 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:ALCHEMIAFACILITY NUMBER:
496803583
ADMINISTRATOR:LIZ JAHRENFACILITY TYPE:
775
ADDRESS:394 TESCONI COURTTELEPHONE:
(707) 978-3229
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY: 45CENSUS: 9DATE:
11/15/2021
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
10:22 AM
MET WITH:Liz Jahren (Administrator)TIME COMPLETED:
11:25 AM
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Licensing Program Analyst (LPA) Cuadra arrived announced to conduct an annual required inspection based on infection control and met with Administrator, Liz Jahren. LPA conducted risk assessment with Administrator. The program is open Monday, Tuesday, Thursday and Friday from 10:00am to 2:00pm. Adult Day Program has a sign-in process for 9 participants and they can come only two days per week. Online classes are provided through zoom to participants daily.

LPA arrived at the facility and had temperature checked and logged. There are 9 participants at the time of visit. Participants were observed participating in personalized activities. Facility has a centralized sign-in sheet where documents staff and participants daily screening. All staff are completely vaccinated and 90% of participants are vaccinated. Participants wear face coverings as tolerated. Staff was observed wearing a mask while in the facility. Day program does not provide transportation. Transportation services are provided by participants responsible parties which will ensure to follow all the precautions. All staff have received required training on infection control. Daily cleaning at the end of day, participants have their own art tools and they are not shared. Automated dispensers to dispense sanitizer.

Facility has posters that are posted through the facility encouraging participants to wear a mask and maintain social distancing. Facility has sufficient personal protective equipment for staff and participants including face shields, gloves, hand sanitizer and masks, participants bring their own meals. If a participant is exhibiting symptoms, they are to stay home and notify the facility. Facility has submitted their Mitigation Plan and it was approved as of 3/2/21.

Administrator agreed to submit the following documents to CCL by 11/22/21: Designation of Responsibility (LIC308), Administrative Organization (LIC309), Affidavit Regarding Client Cash Resources (LIC400), Surety Bond (LIC402) and Personnel Report (LIC500).
No deficiencies cited during today's visit.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2021
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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