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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804147
Report Date: 04/07/2023
Date Signed: 04/07/2023 10:20:35 AM

Document Has Been Signed on 04/07/2023 10:20 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
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:
04/07/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Gerald Corradi-AdministratorTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Alviso, conducted a prelicensing inspection, on 4/7/23 at approximately 9:15am, and met with Administrator Gerald (Jerry) Corradi and Director Jen Whalen. This application is a change of location of the Petaluma day program site to the Rohnert Park location. Component III Orientation was completed on 3/21/23.

The last inspection was on 3/21/23 and there were a few items that needed to be completed; The LPA has observed that the following items are complete.

The building site has all required ceiling tiles in place in all the rooms. All rooms are set up and there are furnishings in rooms that can be used by clients on-site. The facility site has sufficient lighting in all rooms, common areas, and bathrooms. Bathrooms have paper towels, soap. as well as the kitchen. All rooms, areas, and walkways are clear for client, staff and visitors to use safely.

Administrator stated to the LPA that they will ensure the bathroom signage is brought over from the Petaluma site to post in all bathrooms, as soon as the Rohnert Park location is licensed.

The LPA didn't observe any health and safety hazards during today's inspection, 4/7/23. The LPA will forward a copy of the pre-licensing inspection to the Application Unit Analyst; The Application Unit Analyst will contact the applicant with the status of the application.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2023
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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