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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804170
Report Date: 10/22/2024
Date Signed: 10/22/2024 12:45:16 PM

Document Has Been Signed on 10/22/2024 12:45 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 SENIOR ADULT PROGRAMFACILITY NUMBER:
496804170
ADMINISTRATOR/
DIRECTOR:
CORRADI, GERALDFACILITY TYPE:
775
ADDRESS:6597 COMMERCE BLVDTELEPHONE:
(707) 584-5859
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 45CENSUS: 23DATE:
10/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Danielle Schulze-Program ManagerTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Alviso conducted a Required - 1 Year inspection and met with Administrator Danielle Schulze, Program Manager. There were six (6) other staff on duty.

There are thirty (30) participants enrolled in the day program; Today twenty-three (23) attended, and all went into the community with staff supervision. The Program operates on-site Monday through Friday, 9am to 3pm.

Facility is fire cleared for forty-five (45) ambulatory, of which eight (8) may be non-ambulatory, The facility has a required infection control plan. The facility has a required emergency disaster plan. The facility conducts emergency disaster drills, last fire/evacuation drill was held on 7/10/24 and an earthquake drill was held 10/15/24. The facility does not have a medication assistance program, and don't handle medications. Clients have their medications, prior to attending day program, and when returning to their respective homes. No medication assistance at the day program is part of the clients admission agreement.

LPA reviewed five (5) client files. All client files were complete.
LPA reviewed five (5) 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 toured the facility. There are two large bathrooms with multiple stalls for clients use. Cleaners and disinfectants are locked up and inaccessible to clients in care. Hot water was checked at 109.2 degrees Fahrenheit. There is a refrigerator for clients lunches/snacks, and drinks. There is a facility staff refrigerator for staff food items, cooking class items, and any other food items as needed. Sufficient lighting throughout the facility. Fire extinguisher, three (3), were serviced and tagged as required, All exits were marked and free of obstructions. Facility was clean and orderly.

No deficiencies cited today.
Exit interview conducted with Program Manager, Danielle Schulze.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2024
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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