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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804147
Report Date: 06/17/2025
Date Signed: 06/17/2025 01:09:29 PM

Document Has Been Signed on 06/17/2025 01:09 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:
06/17/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Victoria Trentacoste-Program ManagerTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Alviso conducted a case management-incident inspection, on 6/17/25 at approximately 9:00am, and met with Program Manager Victoria Trentacoste.

LPA reviewed a client incident reported to the Department. LPA requested client (C1) records, and staff (S2, S3, S4) records. LPA reviewed facility records regarding the incident. LPA requested document copies from file reviews. All copies were provided to the LPA during the inspection. LPA also requested a current staff roster, current list of all clients participating in the day program, and documentation of S2's termination as a staff member of the day program.
Per review of the client (C1) incident report, and review of records, it was identified that staff S3 reported on 6/5/25 that on 6/2/25, in summary, they had observed inappropriate physical contact between a client (C1) and staff (S2) in the main day program room; Staff S3 reported that several weeks earlier they had observed staff S2 holding hands with client (C1) while walking into the day program site but didn't report it, until today, 6/5/25. Police were contacted by C1's responsible party, it was identified that additional information was obtained regarding suspected sexual abuse of the client. LPA obtained a copy of an SOC341 during today's inspection, 6/17/25.

Licensing agency received a client incident report on 6/11/25; Licensing Agency did not receive an SOC341 Suspected Elder/Adult Abuse report as required by law within required time frame. This deficiency will be cited today, W&I 15630(b)(1) Elderly and Dependent Adult Abuse Mandated Reporting, 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: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 06/17/2025 01:09 PM - It Cannot Be Edited


Created By: Dina Alviso On 06/17/2025 at 11:07 AM
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: 06/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/18/2025
Section Cited
CCR
15630(b)(1)

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W&I 15630(a) Elderly and Dependent adult abuse mandated reporting/reporting Requirements. Telephone and written report must be completed per law, and in compliance with time frames required by law. Based upon interviews and document review, this requirement has not been met as evidenced by: LPAs review of client incident, review of records, and interviews, Staff S3 observed inappropriate touching between a staff and client on 6/2, but reported it on 6/5/25, stating they had also seen
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DEFICIENCY CLEARED- PROGRAM MANAGER VICTORIA TRENTECOSTE PROVIDED PROOF OF IN-SERVICE TRAINING/RELIAS TRAINING REGARDING ABUSE REPORTING/MANDATED REPORTING REQUIREMENTS OF STAFF. POC CLEARED 6/18/25.
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staff (S2) and client (C1) holding hands weeks earlier but had not reported it till 6/5/25. Police were contacted by C1's responsible party, and additional information has been obtained regarding suspected sexual abuse of the client. Administration staff S1 and S5 reported the incident to licensing on 6/11. Licensing Agency did not receive a required SOC341 Suspected Abuse Report from UCPNB-Sonoma Day Program and/or staff (S3) as required by law/and timeframe.This posed an immediate risk to the health and safety of clients in care.
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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.
Bethany Moellers
NAME OF LICENSING PROGRAM MANAGER:
Dina Alviso
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2025


LIC809 (FAS) - (06/04)
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