<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803657
Report Date: 06/18/2024
Date Signed: 06/18/2024 03:05:45 PM

Document Has Been Signed on 06/18/2024 03:05 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/
DIRECTOR:
DEBBIE MCCULLOCHFACILITY TYPE:
735
ADDRESS:1550 N DUTTONTELEPHONE:
(707) 293-3138
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY: 12CENSUS: 12DATE:
06/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Emiley Midyette (House Manager)TIME VISIT/
INSPECTION COMPLETED:
03:18 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Cuadra arrived unannounced for the purpose of conducting a case management to follow up an update to the facility admission agreements and met with Emiley Midyette, House Program Manager.

On June 11, 2024, the Department received an email from Administrator Debbie McCulloch asking for guidance regarding an update to admission agreements indicating no oxygen use allowed at Hope House. However, after review of Title 22 regulations, it was determined that the updated admission agreement indicating their policy about no oxygen could be applied for new admissions only. However, this update of no oxygen would not apply to current residents in care, because it was not agreed upon at admission or in place. In the case that current residents needs use of oxygen, the facility will have to meet the resident’s care needs.

During today's visit, LPA obtained a roster of current residents in care. House Program Manager/Administrator agrees to provide a copy of updated admission agreement and plan of operation to the Department to update their file.

No deficiencies cited during today's visit. Exit interview conducted with House Program Manager and a copy of this report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1