496803583-5-28-2026-21-AS-MCUA-DUHRNX-20260528131103

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 496803583
Report Date: 05/28/2026
Date Signed: 05/28/2026 01:11:26 PM

Document Has Been Signed on 05/28/2026 01:11 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:	ALCHEMIA		FACILITY NUMBER:	496803583
ADMINISTRATOR/ DIRECTOR:	LIZ JAHREN		FACILITY TYPE:	775
ADDRESS:	394 TESCONI COURT		TELEPHONE:	(707) 978-3229
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95401
CAPACITY: 45		CENSUS: 44	DATE:	05/28/2026
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:20 AM
MET WITH:	David Lear (Mentor)		TIME VISIT/ INSPECTION COMPLETED:	01:26 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Marisol Cuadra conducted an unannounced case management and met with mentor David Lear, Administrator Liz Jahren was not able to come to the facility but was available via phone and gave authorization for staff to sign the report. LPA explained to Administrator via phone the purpose of the case management visit was to follow up on incident reports regarding participants' recent falls during the last couple months and obtain additional information about preventive measures taken to prevent these ongoing incidents from keep happening. Per incident report, on 04/01/26 around 2:45pm, participant (P1) was waiting for their bus when P1 reported to Senior Artist Coordinator, that they fell forward on the rug in the big room and landed on their hands and knees due to they were feeling dizzy because they had been sitting with their legs crossed. P1 was assessed and ice packs were applied by facility staff to P1, responsible parties were notified. Staff will continue to remind P1 not to sit with their legs crossed which causes them to get dizzy and to get up slowly and make sure they are not feeling dizzy before they start walking across the room. Based on LPA's records review of P1's physician report dated 10/01/24 and ISP dated 9/7/2025, P1 is ambulatory and is able to care for all personal needs including toileting needs. Another incident happened on 4/21/26 at approximately 9:15am involving participant (P2), who was observed by staff crying in the hallway outside the bathroom and went to find P2 laying face down on the floor. Staff coached them up into a chair to assess for any injuries. P2 reported that they tripped on their way out of the bathroom but could not tell what they tripped on. Per P2, their knee and mild shoulder pain, and confirmed that they did not hit their head or chin, when the mentors found them their feet were both resting on top of their backpack. Continued on LIC809C...

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Marisol Cuadra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/28/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

Page: 2 of 4

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: ALCHEMIA	FACILITY NUMBER: 496803583
	VISIT DATE: 05/28/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued from LIC809...It is unclear weather they dropped their backpack when they tripped or if they tripped over their backpack and their walker was outside the bathroom at the end of the hallway. Responsible parties were notified. Staff will suggest P2 to take their walker into the bathroom with them to assist them with more stability when entering and exiting. Based on records review, the facility does not have a physician report on file for P2, but P2's IPP dated 2/16/23 performed by their placement agency indicates that P2 is independent to perform activities of daily living including toileting, which is in compliance with P2's ISP dated 3/6/26. According to staff, they have a current physician report on file, but LPA was unable to locate it.

The third incident happened in the morning of 04/21/26, inside Alchemia, when participant (P3) was observed tripping, falling onto their knees and onto the floor. P3 immediately got back up onto their feet and was in good spirits. P3 said "is used to falling and feels fine." P3 reported to staff that they tripped over an artist who was blocking their way. However, staff observed P3 bumping into and tripping over a table leg. Several hours later, staff reported that P3 still did not feel any pain or issues related to the fall. Staff will monitor P3 for patterns when falling occurs and remind them to move at a safe pace with awareness of their surroundings. Additionally, staff will consult with P3's support team if concerns about coordination continue.
Another incident involving P3 occurred on 4/23/26 at approximately 2:40pm, while P3 walking in the parking lot after Program with another participant, P3 had turned around to show them their cute t-shirt and when spinning back around they tripped and fell landing on both of their knees cutting and scrapping them badly. Senior Artist Coordinator and Arts Mentor witnessed the fall and ran to assist P3 who had rolled over onto their back crying; Staff applied first aid to P3's knees. Staff will continue to support P3 with gentle reminders to move more slowly when walking anywhere. On 5/8/26 at approximately 12:15pm P3 fell in the bathroom in the big room after lunch. Staff alerted Senior Artist Coordinator who got the key and unlocked the bathroom to find P3 on their hands and knees facing the door. P3 reported that they were throwing away their paper towel when their knee popped out, P3 lost their balance and fell onto both knees. P3 stated that after they fell, then they turned themselves around so they could face the door. Senior Artist Coordinator got a chair and helped P3 to pull themselves up to a standing position, P3's wheelchair was observed outside the bathroom. Staff assessed P3 for injuries and applied two ice packs. Staff will encourage P3 to take their wheelchair into the bathroom with them and will instruct P3 to hold onto the safety bars in the bathroom when moving from one place to another. Staff performed first aid and ice packs, also they wiped up the pilled water on the bathroom floor and notified responsible parties. Based on LPA's records review of P3's physician report dated 12/29/23 and ISP dated 10/2025, P3 is ambulatory and is able to care for all personal needs including toileting needs. Continued on LIC809C...

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Marisol Cuadra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/28/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: ALCHEMIA	FACILITY NUMBER: 496803583
	VISIT DATE: 05/28/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued from LIC809C...

Another incident involving participant (P4) occurred on 5/4/26 at approximately 11am when P4 reported to staff that they slipped on water in the bathroom and landed on their bottom, P4 reported mild soreness on their right side following the fall. The facility staff will encourage and reminded P4 to be aware of their surroundings and reminded all participants to report spills. Additionally, staff contacted with cleaning services to ensure floor mats are non-slip. Based on records review, the facility does not have a physician report on file for P4, but P4's IPP dated 12/28/22 performed by their placement agency indicates that P4 is independent to perform activities of daily living including toileting, which is in compliance with P4's ISP dated 2/4/26. According to staff, they have a current physician report on file, but LPA was unable to locate it.

Last incident report involves participant (P5) who on 5/21/26 at approximately 1:45pm staff observed P5 standing up, then moved to through away a bowl, when they lost their balance and fell landing on their bottom. Staff helped P5 into a chair and reported to Senior Artist Coordinator. Staff assessed P5 for any injuries and remind them to move more slowly when standing up and moving forward. Based on LPA's records review of P5's physician report dated 12/6/2016 and ISP dated 10/20/25, P5 is ambulatory and is able to care for all personal needs.

During today's visit, LPA went over incident details with Administrator via telephone and confirmed that the above details are part of the measures taken by the facility to ensure participants' safety while in the day program as well as collaboratively working with their placement agency to elaborate adequate service plans to address above areas of concern. Administrator agreed to submit a written plan to CCL by not later than 6/5/26 addressing how the facility will ensure the health and safety of participants in care.

No deficiency cited during today's visit. Exit interview was conducted with staff and copy of this report was given.

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Marisol Cuadra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/28/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026

LIC809 (FAS) - (06/04)

Page: 4 of 4