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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803590
Report Date: 11/19/2021
Date Signed: 11/19/2021 10:57:47 AM

Document Has Been Signed on 11/19/2021 10:57 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:COLE VOCATIONAL SERVICES SANTA ROSAFACILITY NUMBER:
496803590
ADMINISTRATOR:CHARLTON, HOLLYFACILITY TYPE:
775
ADDRESS:131-A STONY CIR STE 750TELEPHONE:
(707) 528-3771
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY: 60CENSUS: 0DATE:
11/19/2021
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
09:57 AM
MET WITH:Diana Mendez (Program Supervisor)TIME COMPLETED:
11:13 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 Program Supervisor, Diana Mendez, Regional Director, Cherlyn Cleary and Psychiatric technician, Diane LaFoe. LPA conducted risk assessment with Program Supervisor.

The program is not open for in-person classes, there are 19 participants that are receiving alternative services through online activities and staff drop off activity packages including arts and crafts supplies for participants in average once a week. LPA arrived at the facility and had their temperature checked and logged. Facility has a centralized sign-in sheet located at loading area where facility documents staff, visitors and eventually participants daily screening. All staff are completely vaccinated. Facility will provide transportation services and they will ensure to screen participants before they can get on the vans as well as facility will screen participants at facility entrance. Staff was observed wearing a mask while in the facility. Not all staff have received required training on infection control yet. Regular maintenance plan includes sanitize every two hours or as needed. Facility has automated dispensers to dispense hand sanitizer. Facility has scheduled the staff to be fit tested for N95. However, it had been hard to find three type of N95 sizes.

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. Facility has submitted their Mitigation Plan and it was approved as of 4/13/21. Administrator agreed to notify CCL before re-opening for in-person classes.

Administrator agreed to submit the following documents to CCL by 11/29/21: Designation of Responsibility (LIC308), Affidavit Regarding Client Cash Resources (LIC400), Surety Bond (LIC402), Lease agreement and Personnel Report (LIC500).

No deficiencies cited during today's visit.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2021
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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