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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803583
Report Date: 08/31/2023
Date Signed: 08/31/2023 10:18:06 AM

Document Has Been Signed on 08/31/2023 10:18 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
SANTA ROSA RO, 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: 36DATE:
08/31/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Artist Coordinator, Mary Gannon GrahamTIME COMPLETED:
10:28 AM
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Licensing Program Analyst Bertozzi arrived unannounced to conduct a Case Management visit and met with Artist Coordinator, Mary Gannon Graham.

LPA is following up regarding a recent self-reported incident where a participant had an electronic device go missing and it was discovered that another participant (P1) had taken it. Facility was able to recover the electronic device. Due to a history of theft, facility has spoken with P1's responsible parties to request additional support. Until additional support is provided, facility staff have increased supervision.

No deficiencies cited during this inspection.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2023
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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