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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804170
Report Date: 10/15/2025
Date Signed: 10/15/2025 02:22:21 PM

Document Has Been Signed on 10/15/2025 02:22 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: 24DATE:
10/15/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Jerry Coradi-Administrator/DirectorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Alviso conducted a Required - 1 Year inspection, on 10/15/25, and met with Area Program Director, Jerry Coradi, and Assistant Program Coordinator Jessica Cilia,

There were (6) other staff on duty; Twenty-eight (28) clients are enrolled in day program services, and there are twenty-four (24) clients in attendance today. This morning twenty (20) of the clients went into the community with staff supervision, four chose to stay on-site. This afternoon a walk is scheduled with all twenty-four (24) participants. The Program operates on-site Monday through Friday, 9am to 3pm.

Facility is fire cleared for forty-five (45) total, of the forty-five (45), eight (8) may be non-ambulatory, The facility has a required infection control plan. The facility has a required emergency disaster plan. Per record review, the facility conducts emergency disaster drills as required.

Currently the facility does not have a medication plan in the program, and does not handle medications. No medication assistance is provided by staff at the day program; This is noted and part of the clients' admission agreement, regarding no medication assistance.

The LPA reviewed six (6) client files. The client files were complete.

The LPA reviewed six (6) staff files. All staff have criminal record clearance as required. All staff have first aid certification and CPR certification as required. LPA reviewed staff training.

Continued on LIC809C..
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Dina Alviso
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2025
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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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 SENIOR ADULT PROGRAM
FACILITY NUMBER: 496804170
VISIT DATE: 10/15/2025
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LPA toured the facility.. Cleaners/disinfectants, cleaning tools/janitorial supplies are locked up and inaccessible to clients in care. 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 was observed in the main common area, all client classrooms, activity rooms, restrooms, for use by clients in care. There are two large bathrooms with multiple stalls for clients use; Bathrooms had accessible paper towels, and hand soap for clients use. Fire extinguisher, three (3), were serviced and tagged as required, All exits were marked and free of obstructions as required. Facility was clean and orderly during the inspection. Facility was observed to be at a comfortable temperature during the inspection. LPA observed clients involved in activities during the inspection, clients, and some staff having their lunch at noon, and clients interacting with the staff on duty.

Licensee to submit the following annual forms by 11/15/25:
LIC500- Personnel Report
LIC308- Designation of Responsibility
LIC610D-(9 page) Emergency Disaster Plan- Review &update if needed. Submit copy
LIC400-Affidavit Regarding Client Cash Resources- complete the form
LIC402-Surety Bond (if handling client cash)
Infection Control Plan- Review &update if needed. Submit copy

There are no deficiencies cited today.
Exit interview conducted with Jerry Coradi, Area Program Director.
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Dina Alviso
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
LIC809 (FAS) - (06/04)
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