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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803613
Report Date: 09/16/2021
Date Signed: 09/16/2021 02:00:30 PM

Document Has Been Signed on 09/16/2021 02:00 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:ALLIED INTEGRATION SERVICESFACILITY NUMBER:
496803613
ADMINISTRATOR:VANDERVILLE, ERICFACILITY TYPE:
775
ADDRESS:50 EXECUTIVE AVETELEPHONE:
(707) 586-1799
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 30CENSUS: 16DATE:
09/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Eric Vanderville-CEOTIME COMPLETED:
01:55 PM
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Licensing Program Analyst (LPA) Dina Alviso arrived unannounced to conduct an 1-YR Required inspection and met with CEO Eric Vanderville. LPA observed three other staff working in the day program today. There were no clients on-site; There are currently sixteen clients that are part of the virtual day program zoom classes. The virtual program currently consists of 3 days zoom classes, and two days of 1 to 1 staffing of each client and accessing the community.

The inspection is focused on the Infection Control procedures and practices of this facility.

Mitigation plan was approved by the Department on 3/16/21. Fire extinguishers were current, serviced and tagged as required. All exits were observed to be clear of any obstructions.
Clients are screened before being allowed entrance into the facility. All staff and visitors are screened before being allowed to remain in the facility. All screenings, including screening questions, temperatures being taken, and all information being logged. Facility was found to be clean, orderly, and at a comfortable temperature. Toxins are stored in a locked closet. There was a sufficient supply of hygiene products, paper products, and cleaners. All postings were up and visible to all as required. Facility has a sufficient supply of personal protective equipment(PPE). All staff have access to the PPE supply as needed. Hand Sanitizer automatic dispensers are throughout the facility for staff, visitors, and clients use. CEO stated that staff, visitors, and clients wear masks in the facility. CEO and staff on-site were observed by the LPA to be wearing PPE masks.
No citations issued.
Exit interview conducted with Eric Vanderville, CEO.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2021
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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