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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803590
Report Date: 11/05/2024
Date Signed: 11/05/2024 02:32:16 PM

Document Has Been Signed on 11/05/2024 02:32 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:COLE VOCATIONAL SERVICES SANTA ROSAFACILITY NUMBER:
496803590
ADMINISTRATOR/
DIRECTOR:		LUCAS, SARAHFACILITY TYPE:
775
ADDRESS:131-A STONY CIR STE 750TELEPHONE:
(707) 528-3771
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY: 60CENSUS: 20DATE:
11/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Diana Mendez (Program Manager)TIME VISIT/
INSPECTION COMPLETED:
02:47 PM
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required inspection and followed up on SOC341 along with an incident report. Program Manager, Diana Mendez greeted LPA. Required postings were observed. Annual fees are current.

LPA/staff initiated tour of the facility and observed the following: Facility has a large open/pocket area for participant's activities, changing rooms, administrative offices, quiet room, three bathrooms, kitchen and dining area. Toxins are stored in various locked closets/storage rooms. One locked storage room containing cleaning supplies near the washer and dryer. Medications are centrally stored in the nurses office. A refrigerator is located in the kitchen to accommodate client lunches and snacks. Water temperature in bathroom read at 108.7 and 110.7 which is within regulation of 105 and 120 degrees F. Clients were participating in variety of activities at the time of visit.

Fire extinguishers are fully charged and were last serviced January 2024. Sprinklers and pull stations are located throughout the facility and are tested regularly by a vendor who contracts with the landlord. First aid kits were observed. Carbon monoxide detectors were present and working at the time of visit. Program does not provides transportation. Medications & records were reviewed. One Licensed Vocational Nurse (LVN) is at the facility whenever clients are present to support clients with restricted health care needs. Per Administrator, the facility is not accepting individuals into the program until they have an additional LVN to safely support the participants in care and NBRC has placed them on the no referral list.

Continue on LIC 809C
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
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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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: COLE VOCATIONAL SERVICES SANTA ROSA
FACILITY NUMBER: 496803590
VISIT DATE: 11/05/2024
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Continued from LIC809

File review was initiated at 12:00pm. Three staff files and ten participant files were reviewed. Staff records included required training hours and current First Aid/CPR training on file. Three out of ten participants (P1, P2 & P3) files did not have medical assessments on file (Technical violation issued). Needs and services plan were updated for participants. The facility does not handle cash resources.

During today's visit, LPA is following up on SOC341 along with an incident report received by the Department regarding participant (P1). Per SOC341, "on 10/14/24 at approximately 9am arrived to day program when staff noticed that they had a bruise (purple and blue) on their right lower eye. P1 did not seem to be experiencing any pain. LVN assessed P1, contacted their responsible party who told staff that the incident had occurred during the weekend while they were being changed. P1 seemed to be upset, they were trying to pull their GT out, trying to hurt themselves and home staff, which resulted in a self-injury by hitting their right eye. Day program monitored P1 and completed reporting requirements to all agencies involved including law enforcement case #24-12130". LPA reviewed P1's files and they live with their responsible party. The facility did not report any further incidents.

LPA has requested updates copies of the following document be submitted to CCL by 11/12/2024: copy of current lease agreement.

No deficiencies cited during today's visit. Exit interview conducted with Program Manager and a copy of this report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC809 (FAS) - (06/04)
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