496803590-10-17-2025-21-AS-MCUA-DMJQ3E-20251017114838

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 496803590
Report Date: 10/17/2025
Date Signed: 10/17/2025 11:48:52 AM

Document Has Been Signed on 10/17/2025 11:48 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:	COLE VOCATIONAL SERVICES SANTA ROSA		FACILITY NUMBER:	496803590
ADMINISTRATOR/ DIRECTOR:	MENDEZ, DIANA		FACILITY TYPE:	775
ADDRESS:	131-A STONY CIR STE 750		TELEPHONE:	(707) 528-3771
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95401
CAPACITY: 60		CENSUS: 16	DATE:	10/17/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:03 AM
MET WITH:	Diana Mendez (Program Manager)		TIME VISIT/ INSPECTION COMPLETED:	12:07 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required inspection and was greeted by Program Manager, Diana Mendez. Required postings were observed. Annual fees are current. Contact information was reviewed. LPA/staff initiated tour of the facility and observed the following: Facility has a large open area for participant's activities, changing rooms, administrative offices, quiet room, four 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. Snacks are provided to participants. Water temperature in bathroom read at 106.8 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 February 2025. Sprinklers and pull stations are located throughout the facility and are tested regularly by a vendor who contracts with the landlord, their last inspection was done in September 2025. First aid kits were observed. Carbon monoxide detectors were present and working at the time of visit. Last disaster drill was conducted on 9/30/25. Program does not provides transportation. Medications & records were reviewed. Continue on LIC 809C...

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Marisol Cuadra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/17/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: 10/17/2025

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Continued from LIC809

File review was initiated at 9:30am. Three staff files and five participant files were reviewed. Staff records included required training hours and current First Aid/CPR training on file. Five participants files have medical assessments on file and individual services plans were updated. The facility does not handle cash resources. One Licensed Vocational Nurse (LVN) is at the facility whenever clients are present to support clients with restricted health care needs. Per Program Manager, 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. During file review, it was discovered that some participant's physician report indicates bedridden and non-ambulatory status, LPA reviewed approved fire clearance dated 11/5/2015 that allows for 60 non-ambulatory participants and no bedridden. LPA discussed with Program Manager the issue and it was disclosed that current physician's reports on file were provided by participant's home and not obtained by the day program. However, participants are not fully bedridden, so the facility agrees to obtain clarification and update participant's physician reports to reflect correct ambulatory status. The facility has 2:1 participant's ratio requirement as identified in their Individual Services Plans and staffing schedule is compliant with required staffing ratios.

LPA has requested updates copies of the following document be submitted to CCL by 10/24/2025: LIC500 Personnel Report.

No deficiencies cited during today's visit. Exit interview conducted with Program Manager and a copy of this report was given.

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Marisol Cuadra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/17/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

LIC809 (FAS) - (06/04)

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