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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803761
Report Date: 03/29/2022
Date Signed: 03/29/2022 12:32:21 PM

Document Has Been Signed on 03/29/2022 12:32 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:PRIMROSE SANTA ROSA DAY CLUBFACILITY NUMBER:
496803761
ADMINISTRATOR:WOTRING, JOHNFACILITY TYPE:
775
ADDRESS:2086 GUERNEVILLE RDTELEPHONE:
(707) 578-8360
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY: 25CENSUS: 6DATE:
03/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:John Wotring-LicenseeTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA), Dina Alviso, is conducting a Required 1-Year inspection, and met with Licensee John Wotring. Cynthia Tilker is Program Director. The inspection is focused on the Infection Control procedures and practices of this facility.

Mitigation plan was submitted and reviewed by the Department. Fire extinguishers were serviced and tagged as required-dated 6/2/21. The day program has a fire clearance approval for 25 ambulatory clients. There are six(6) clients enrolled in day care services at this time. Per the Licensee, the day program is operating at a lower capacity to ensure health and safety of all clients in care, and ensure compliance with facility's mitigation plan.

The day program operates Monday through Friday, 9am to 5pm. All clients are screened, and temperatures taken, all information is logged. All clients, visitors, and staff are screened before being allowed to remain in the facility. During the inspection, LPA observed the clients at a large table with staff, who were engaging them into conversation. Facility was found to be clean, orderly, and at a comfortable temperature with all exits free from obstruction. Toxins are stored in locked cabinets. 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). Clients have masks available to them for their use if needed and/or wanted. All staff have access to the PPE supply as needed. Hand Sanitizer automatic dispensers are throughout the facility for staff, visitors, and clients use. Licensee stated that staff, visitors, and clients wear masks in the facility. Licensee and staff on-site were observed by the LPA to be wearing appropriate PPE masks.
No citations issued.
Exit interview conducted with the Licensee.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2022
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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