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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804147
Report Date: 03/24/2025
Date Signed: 03/24/2025 01:26:24 PM

Document Has Been Signed on 03/24/2025 01:26 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:UCPNB-SONOMA DAY PROGRAMFACILITY NUMBER:
496804147
ADMINISTRATOR/
DIRECTOR:		CORRADI, GERALDFACILITY TYPE:
775
ADDRESS:6593 COMMERCETELEPHONE:
(707) 763-9807
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 75CENSUS: 35DATE:
03/24/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Victoria Trentacoste-Program ManagerTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Alviso conducted a Required - 1 Year inspection, on at approximately 9:45am, and met with Program Manager, Victoria Trentacoste.

Today, there are thirty-five (32) participants at day program services. Participants do access the community for jobs, outings, and activities, with care and supervision by staff.

The facility has a required infection control plan. The facility has a required emergency disaster plan. 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.

Facility is fire cleared for 70 ambulatory and 5 non-ambulatory, The facility conducts required emergency drills, last drills were held on 2/4/25 and 23/3/25. The program conducts emergency drills monthly per file review. Five (5) fire extinguishers were serviced and tagged as required.

LPA reviewed six (6) client files. LPA reviewed six (6) staff files. Staff have criminal record clearance as required. Staff have required annual training.

LPA toured the facility with Program Manager Victoria. Hot water was measured at 119. degrees Fahrenheit. All exits were unobstructed. The day program has an open large common area for use by clients; The staff office rooms, conference room, and classrooms, all have key pad locks on them that must be opened by a staff for clients use. These rooms are staffed/supervised at all times when in use by clients per Program Manager, and plan of operation.

Continued on LIC809C...
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Dina Alviso
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2025
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: UCPNB-SONOMA DAY PROGRAM
FACILITY NUMBER: 496804147
VISIT DATE: 03/24/2025
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There are two large bathrooms with multiple stalls, and a single use bathroom for use by clients. All bathrooms had soap and paper towels for use as needed. The bathrooms don't have key pad locks and are accessible at all times to clients, per plan of operation. There is an open area kitchen with a refrigerator for clients use to store drinks and lunches/snacks, this is accessible to clients at all times, per plan of operation.. There was sufficient lighting in all areas of the day program. The facility was at a comfortable temperature during the inspection. Facility was clean and orderly during the inspection. All cleaners/disinfectants were locked up and inaccessible to clients in care. Facility had sufficient supply of paper products, soap, and personal protective equipment (PPE) for use as needed.

Licensee to submit the following annual forms by 4/24/25:
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.

The following deficiency was observed per staff file reviews:

Staff, S1 through S6, lack current required first aid and CPR certification; Per interview with Program Manager Victoria Trentacoste, all the program staff, twelve (12), that work regularly, all lack first aid and CPR certification. This is a requirement in order to provide direct care and supervision to participants of the day program. This deficiency will be cited, 82075(f) Health Related Services- Staff responsible for providing direct care and supervision shall receive and maintain current training in first aid and cardiopulmonary resuscitation from persons qualified by agencies including, but not limited to, the American Red Cross, see LIC809D.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.

Exit interview conducted with Program Manager Victoria Trentacoste. Appeal Rights provided.

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Dina Alviso
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/24/2025 01:26 PM - It Cannot Be Edited


Created By: Dina Alviso On 03/24/2025 at 01:06 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: UCPNB-SONOMA DAY PROGRAM
FACILITY NUMBER: 496804147

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/24/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82075(f)
Health-Related Services
(f) Staff responsible for providing direct care and supervision shall receive and maintain current training in first aid and cardiopulmonary resuscitation from persons qualified by agencies including, but not limited to, the American Red Cross.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's file reviews and interview with Program Manager, S1 through S6, lack current required first aid and CPR certification; Per interview with Program Manager Victoria Trentacoste, all the program staff, twelve (12), that work regularly, all lack first aid and CPR certification. This is a requirement in order to provide direct care and supervision to participants of the day program, the licensee did not comply with the section cited above in [6] out of [6] record reviews, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/25/2025
Plan of Correction
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Licensee to ensure all staff obtain first aid and CPR certification as required by regulation. Ensure staff stay in future compliance with this regulation requirement. Submit follow-up of proof of all staff having obtained first aid & CPR certification by 3/25/25. POC due 3/24/2025.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Bethany Moellers
LICENSING EVALUATOR NAME:Dina Alviso
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2025


LIC809 (FAS) - (06/04)
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