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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803590
Report Date: 03/20/2025
Date Signed: 03/20/2025 01:02:50 PM

Document Has Been Signed on 03/20/2025 01:02 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:		MENDEZ, DIANAFACILITY TYPE:
775
ADDRESS:131-A STONY CIR STE 750TELEPHONE:
(707) 528-3771
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY: 60CENSUS: 17DATE:
03/20/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:55 AM
MET WITH:Diana Mendez (Program Manager)TIME VISIT/
INSPECTION COMPLETED:
01:17 PM
NARRATIVE
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a Case Management - Incident Visit and met with Diana Mendez, Program Manager. The purpose of this Case Management Visit is to conduct a follow up on SOC341 report submitted to Community Care Licensing (CCL) on 3/12/25.

Per SOC341, On 3/11/25 at approximate 2:30pm staff (S1) was sent home due to them falling asleep at day at day program while they were supposed to be caring and supervising participants in care. Upon S1 was sent home, participant (P1) told Program Manager that they needed to use the restroom, when Program Manager assisted P1 with incontinence care it was discovered that their depend was overly soaked, as well as their underwear and pants, which it was concerning due to P1 uses restroom frequently and it appeared like they were not been assisted with incontinence care for a while. S1 was put on administrative leave due to potential neglect to care for P1. Quality Insurance Specialist (QIS) of the facility interviewed S1, where it was disclosed that S1 couldn't recall the last time that they have assisted P1 with incontinence care that day and there was no documentation of assistance recorded at facility documents for this date. According to QIS, today there will be a wrap up call to close up the case were the findings could result in termination of S1 or their acceptance to continue working at the facility. LPA requested a copy of their findings to be sent to CCL.

Continued on LIC809C...

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2025
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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Document Has Been Signed on 03/20/2025 01:02 PM - It Cannot Be Edited


Created By: Marisol Cuadra On 03/20/2025 at 11:55 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: COLE VOCATIONAL SERVICES SANTA ROSA
FACILITY NUMBER: 496803590

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/21/2025
Section Cited
CCR
82065(a)

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82065 (a) Personnel Requirements. (a) Program personnel shall be competent to provide the services necessary to meet individual client needs...This requirement has not been met as evidence by:
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The Program Director agrees to submit a written plan how they will address this incident with S1 and what will be their plan of action to prevent this type of incidents to happen in the future by POC due date.
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Based on observations, interviews and records review the facility did not comply with above section by not ensuring that P1 was assisted with incontinence care needs as stated in their IPP and physician report which poses an immediate risk of health and safety of participants in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Bethany Moellers
LICENSING EVALUATOR NAME:Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2025


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: 03/20/2025
NARRATIVE
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Continued from LIC809...

During today's visit, LPA interviewed QIS who confirmed to LPA their findings of their internal investigation, where S1 was unable to provide accurate information whether they assisted P1 or not with incontinence care needs. Also, QIS disclosed that S1 was previous to this incident, S1 was been talked about appearing to be tired and was advised to call out if they were feeling tired. Today, the facility have scheduled a meeting with S1 to discuss these incidents. Based on records review, P1's physician report revealed that they need assistance with toileting needs and their pre-admission appraisal dated 6/23/24 and individual program plan dated 8/30/23 confirms the need of assistance with incontinence care needs. Also, toileting data sheet for the month of March 2025 confirms that on 3/7/25, P1 was not assisted with incontinence care until 1pm. Program Manager LPA was provided with police report filed with Santa Rosa Police SR#25-2987.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.

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: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025
LIC809 (FAS) - (06/04)
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