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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804147
Report Date: 03/21/2023
Date Signed: 03/21/2023 02:40:24 PM

Document Has Been Signed on 03/21/2023 02:40 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:UNITED CEREBRAL PALSY OF NORTH BAY- OADSFACILITY NUMBER:
496804147
ADMINISTRATOR:CORRADI, GERALDFACILITY TYPE:
775
ADDRESS:6593 COMMERCETELEPHONE:
(707) 766-9990
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 75CENSUS: 0DATE:
03/21/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:16 PM
MET WITH:Gerald Corradi-Administrator TIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Alviso, conducted a prelicensing inspection, on 3/21/23 at approximately 1:10pm, and met with Administrator Gerald (Jerry) Corradi who will also be the facility's Administrator. This application is a change of location of the Petaluma site to the Rohnert Park location. Component III Orientation was completed during the inspection.

LPA discussed the infection control plan with the Administrator. Facility is fire cleared for 70 ambulatory and 5 non-ambulatory, effective 3/2/23. Applicant has submitted an infection control plan for the home as required.
There are four(4) fire extinguishers, inspected and tagged as required- expires 9/12/23.
All exits were unobstructed during the inspection.
There are two(2) single use bathrooms, one men's bathroom with two(2) stalls and a urinal, and a womans bathroom with three stalls. There are sinks in the bathrooms for use as needed. There is a kitchen with a large round table, sink, range, and refrigerator. The space has sufficient lighting throughout.
The space has all necessary and required utilities on and operating appropriately. Hot water was checked at 120.F; The LPA asked the Administrator to monitor the hot water and ensure it doesn't go any higher than 120F, and no lower than 105F, per regulations.

The LPA observed the space has some ceiling tiles out exposing wiring and a bathroom plug outlet missing the cover. The space needs to be set up, and offices and common areas need to be set up and free of any items not remaining in the building. Any packaging items needing to be discarded to be done. Ensuring that bathrooms and kitchen have paper towels set up, soap, and any bathroom signage can be posted (hand washing sign). Administrator stated the space will be set up by next week sometime.

The Administrator will contact LPA when the items listed above are complete;
LPA will schedule another prelicensing continued inspection to reinspect as needed.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2023
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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