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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803657
Report Date: 03/28/2024
Date Signed: 03/28/2024 12:40:27 PM

Document Has Been Signed on 03/28/2024 12:40 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:HOPE HOUSEFACILITY NUMBER:
496803657
ADMINISTRATOR:MOORE, SHANICEFACILITY TYPE:
735
ADDRESS:1550 N DUTTONTELEPHONE:
(707) 293-3138
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY: 12CENSUS: 11DATE:
03/28/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:26 AM
MET WITH:Rita Larson (Social Rehab Director)TIME COMPLETED:
12:55 PM
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a Case Management Inspection and met with Rita Larson (Social Rehab Director).

During today's visit LPA is following up on an incident report received at CCL on 3/11/24 involving Client (C1). Per incident report, on 3/10/24 at around 9:30am (C1) was been assisted with their daily medication at the office when they accidentally dropped a pill on the floor, while trying to pick it up, they dumped the container containing sharp item, scratched themselves on a sharp item. Staff immediately contacted 911, transported C1 to the hospital for further evaluation and testing, where they were given precautionary shots and antibiotics. The facility notified responsible parties including CCL about the incident. During today's visit, LPA was provided with C1's discharge documents where the reason for visit states needle stick with a diagnosis of abrasion of finger and exposure to blood-borne pathogen. Per discharge documents, C1 was tested for a variety of items, given medications and shots to prevent any further incidents. Also, LPA conducted interviews with staff who stated that they used to keep sharp container of used needles under the desk where clients are assisted with their daily medications, but since the incident happened, the facility has implemented a new process to move the container into the medication room and the staff will only bring it out when they need to dispose a needle.

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 Social Rehabilitation Director and a copy of this report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2024
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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Document Has Been Signed on 03/28/2024 12:40 PM - It Cannot Be Edited


Created By: Marisol Cuadra On 03/28/2024 at 12:20 PM
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: HOPE HOUSE
FACILITY NUMBER: 496803657

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/29/2024
Section Cited
CCR
80092.8(qa)(5)

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80092.8(a)(5) Diabetes. The licensee ensures that syringes and needles are disposed of in accordance with California Code of Regulations, Title 8, Section 5193.
Ths requirement is not met as evidenced by:**
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The facility will submit a written statement about the new policy that has been implemented to ensure proper disposal of sharp container items by POC due date to clear the deficiency.
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Based on LPA's records review and staff interviews, the facility staff did not comply with regulation by not ensuring to utilize proper universal precaution of sharps safely and disposed of needles resulting in client (C1) poked their finger, which poses an immediate risk to the health and safety of clients 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: 03/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2024


LIC809 (FAS) - (06/04)
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