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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803583
Report Date: 03/26/2024
Date Signed: 03/26/2024 10:10:09 AM

Document Has Been Signed on 03/26/2024 10:10 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, 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: 37DATE:
03/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:46 AM
MET WITH:Mary Gannon Graham (Artist Coordinator)TIME COMPLETED:
10:25 AM
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Licensing Program Analyst (LPA) Cuadra conducted an unannounced case management and met with Mary Gannon Graham (Artist Coordinator). The purpose of the case management visit was to obtain additional information regarding two recent incidents along with SOC 341 that was self-reported by the facility on 3/8/2024.

The first incident report received and SOC341 involving participant (P1) alleged physical abuse dated 3/8/24. Per incident report and SOC341, staff reported to facility artist coordinator that P1 told them that they were chocked and slapped by their parent that morning while they were getting their lunch and bottle of water. Artist coordinator inquired further about it, but P1 has language limitations that it makes it challenging for staff to communicate with them, and P1 did not provide further details. Artist coordinator proceeded to fill out SOC341 and cross reported to appropriate agencies including CCL. Based on records review, P1 lives with their parents. During today's visit, LPA was able to talk to participant who has some language limitations. No further incidents have been reported.

The second incident report was dated 3/13/24 involving participant (P2). Per incident report, after P2 heated up their lunch was observed by staff at the sink with their arm under cold water, so staff inquired the reason and they were told by P2 that they have spilled some of their lunch on them by accident. Staff assessed P2's arm and applied burn cream to the area and notified the incident to their responsible parties including CCL. P2 has been monitored during the rest of the day and no further issues were reported. During today's visit, LPA reviewed P2's records including their individual service plan dated 1/17/24 that indicates that P2 attends the day program in average of once per week and is able to perform activities of daily living independently. However, the facility has implemented a process of assisting participants to carry their lunches to their tables when needed. LPA was unable to talk to participant because today they did not attend to day program.

No deficiencies cited during today's inspection. Exit interview conducted with Artist Coordinator and a copy of this report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2024
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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