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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803613
Report Date: 09/09/2022
Date Signed: 09/09/2022 11:50:38 AM

Document Has Been Signed on 09/09/2022 11:50 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: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: 14DATE:
09/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Dawn Cuellar- DirectorTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Dina Alviso arrived unannounced to conduct a Required -1 Year inspection and met with Director Dawn Cuellar. There are no clients on-site on Fridays; Day program runs Tuesday through Thursday, and there is still a virtual program that runs on Monday and Fridays. Currently there are fourteen(14) clients enrolled for the on-site day program.

The inspection is focused on the Infection Control procedures and practices of this facility. LPA was screened as required. Director was wearing a mask as required.

The facility did submit the required Infection Control Plan to Licensing. Fire extinguishers were current, serviced and tagged as required- expire 10/8/2022. 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, and temperatures are being logged as required. Facility was found to be clean, orderly, and at a comfortable temperature. Toxins are stored in a locked closet.

All postings were up and visible to all as required. There was a sufficient supply of hygiene products, paper products, and cleaners. 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. No deficiencies or citations issued.
Exit interview conducted with Dawn Cuellar, Director.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2022
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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