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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804147
Report Date: 12/13/2024
Date Signed: 12/13/2024 02:05:06 PM

Document Has Been Signed on 12/13/2024 02:05 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
SANTA ROSA RO, 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) 763-9807
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 75CENSUS: 75DATE:
12/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Victoria Trentacoste-Program ManagerTIME VISIT/
INSPECTION COMPLETED:
02:15 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) Alviso conducted a case management-incident inspection, on 12/13/24 at approximately 12:45pm, and met with Program Managers, Victoria Trentacoste and Danielle Schulze. Director Jen Whalen arrived to the facility to meet with the LPA along with Program Director Danielle.

LPA reviewed a client incident reported to the Department. LPA requested client (C1 & C2) records. LPA requested copies of documents from both records. All copies were provided to the LPA.

LPA also requested a current staff roster, current list of all clients participating in the day program, and documentation of C1's self-discharge from the day program. Copies were provided to the LPA.

There are no deficiencies cited during today's inspection.
Exit interview was conducted with Danielle Schulze, Program Manager, and Jen Whalen, Director.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2024
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