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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803613
Report Date: 10/24/2024
Date Signed: 10/24/2024 11:20:47 AM

Document Has Been Signed on 10/24/2024 11:20 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:ALLIED INTEGRATION SERVICESFACILITY NUMBER:
496803613
ADMINISTRATOR/
DIRECTOR:
VANDERVILLE, ERICFACILITY TYPE:
775
ADDRESS:50 EXECUTIVE AVETELEPHONE:
(707) 586-1799
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 30CENSUS: 16DATE:
10/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Dawn Cuellar- Program DirectorTIME VISIT/
INSPECTION COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Alviso arrived unannounced to conduct a Required -1 Year inspection, approximately 9:20am on 10/24/24, and met with Program Director Dawn Cuellar.

Currently there are seventeen (17) clients enrolled in day program; There are sixteen (16) in attendance today, and all clients went into the community supervised by staff.

Facility is fire cleared for thirty (30) clients, of which four (4) may be non-ambulatory. Facility has an infection control plan as required. Facility has an emergency disaster plan as required. Last fire drill, evacuation drill, was completed on 9/23/24, during program services.

The LPA reviewed five (5) client files. All client files were complete. The LPA reviewed five (5) staff files. All staff had required criminal record clearance. Staff had required training, first aid and cpr certification.

LPA toured the facility with the Program Director. All exits were free and clear of any obstructions. Facility was clean and orderly. LPA observed that the facility had sufficient lighting throughout the common areas. Facility had a required carbon monoxide detector. Disinfectants/cleaners were locked up and inaccessible to clients in care. Hot water was checked at 109.2 degrees Fahrenheit. Facility had automatic sanitizer stands in different areas for client use. Client lunches are stored in a refrigerator in the small kitchenette area. Program has many art and craft items, games, and other miscellaneous items for client activities.

No deficiencies cited during today's inspection.
Exit interview conducted with the Program Director Dawn Cuellar.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2024
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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