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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804147
Report Date: 04/29/2024
Date Signed: 04/29/2024 12:35:35 PM

Document Has Been Signed on 04/29/2024 12:35 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 THE NORTH BAY - OADSFACILITY NUMBER:
496804147
ADMINISTRATOR/
DIRECTOR:		CORRADI, GERALDFACILITY TYPE:
775
ADDRESS:6593 COMMERCETELEPHONE:
(707) 766-9990
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 75CENSUS: DATE:
04/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Gerald (Jerry) Corradi-AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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Licensing Program Analysts (LPA) Alviso conducted a Required - 1 Year inspection, on 4/29/24 at approximately 9:25am, and met with Administrator Jerry Corradi.

Today, there are thirty-two (32) participants at day program services, and seventeen (17) are in the community. The Program operates on-site Monday through Friday, 9am to 3pm.

Facility is fire cleared for 70 ambulatory and 5 non-ambulatory, The facility has a required infection control plan. The facility has a required emergency disaster plan. The facility conducts required quarterly emergency drills, last drill was held on 3/8/24 and was a fire/evacuation drill. The program conducts emergency drills monthly per file review.The facility does not have a medication assistance program plan as part of their plan of operation. Clients have their medications, prior to attending day program, and after attending day program, in their respective homes. No medication assistance at the day program,this is part of clients admission agreement.

LPA reviewed eight (8) client files. All client files were complete.

LPA reviewed eight (8) staff files. All staff had criminal record clearance as required. All staff had first aid and cpr certification. All staff had training as required.

LPA entered into the lobby area of the facility, there is a receptionist area. The facility space is open, and was found to be clean and orderly during the inspection. There are two large bathrooms with multiple stalls, and a single use bathroom; All bathrooms, were observed to be clean and orderly. Cleaners and disinfectants are locked up and inaccessible to clients in care.

All walkways and exits were unobstructed and clear. Fire extinguishers, four (4) were serviced and tagged as required. The facility has a kitchen, with a stove, counter top, and a refrigerator; The stove is used for cooking classes, and can be used to heat up food.
Continued on LIC809C...
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 THE NORTH BAY - OADS
FACILITY NUMBER: 496804147
VISIT DATE: 04/29/2024
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The refrigerator holds drinks/water, client lunches, and snacks. Hot water was checked at 120. degrees Fahrenheit. There are multiple rooms used for different types of activities/classes/meetings for clients in care. There is a quiet room, an art/music room, a meditation room/movie/other activity room, production room/classroom, and a large conference room. There are multiple staff office rooms, and a large open area with tables and chairs for client use. Administrator stated that they do have access to a garden area space shared with another neighboring site, and clients have access to eat their lunches there, with staff supervision.

Licensee to submit the following annual forms by 5/29/2024:
LIC500- Personnel Report
LIC308- Designation of Responsibility
LIC610D- Emergency Disaster Plan-updated & reviewed as needed. submit copy if changes, submit last page signed and dated if no changes.
LIC400-Affidavit Regarding Client Cash Resources (must be completed)
LIC402-Surety Bond (if handling client cash)
Infection Control Plan-updated & reviewed as needed- submit copy if changes, submit last page signed and dated if no changes.

No deficiencies cited today.
Exit interview conducted with Administrator Jerry Corradi.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024
LIC809 (FAS) - (06/04)
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