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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803583
Report Date: 09/15/2022
Date Signed: 09/15/2022 12:04:12 PM

Document Has Been Signed on 09/15/2022 12:04 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:ALCHEMIAFACILITY NUMBER:
496803583
ADMINISTRATOR:LIZ JAHRENFACILITY TYPE:
775
ADDRESS:394 TESCONI COURTTELEPHONE:
(707) 978-3229
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY: 45CENSUS: 24DATE:
09/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Elizabeth Clary (Executive Director)TIME COMPLETED:
12:19 PM
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Licensing Program Analyst (LPA) Cuadra arrived announced to conduct an annual required inspection based on infection control and met with Executive Director Elizabeth Clary and Artist Coordinator, Mary Gannon-Graham. The program is open Monday, Tuesday, Thursday and Friday from 9:00am to 3:00pm and beginning December 2022 the day program will be open five days per week. Adult Day Program has a sign-in process for 24 participants and they can come only three 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 24 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 attendance. However, daily screening is conducted but not documented. Per Executive Director, the facility was instructed not to do so due to a HIPAA regulation. LPA/Executive Director discussed the importance of documenting daily screening results. Executive Director agreed to implement a different system to document that the criteria has been met per regulation. All staff are completely vaccinated and boosted. However, three out of twenty-four participants are not completely 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 and have been N95 fit tested. Daily cleaning at the end of day, participants have their own art tools and they are not shared. Automated dispensers to dispense sanitizer was observed. 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 approved as of 3/2/21. Last disaster drill was conducted on August 2022, Fire extinguishers were found serviced and charged as of June 2022. Fire Department came out today to inspect the sprinklers and alarms. Facility provided updated copies of the following documents: Designation of Responsibility (LIC308), Administrative Organization (LIC309), Affidavit Regarding Client Cash Resources (LIC400), Control of Property, Emergency Disaster Plan (LIC610E) and Personnel Report (LIC500). No deficiencies cited during today's visit.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2022
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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