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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804198
Report Date: 04/29/2024
Date Signed: 04/29/2024 11:09:08 AM

Document Has Been Signed on 04/29/2024 11:09 AM - 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:BECOMING INDEPENDENTFACILITY NUMBER:
496804198
ADMINISTRATOR/
DIRECTOR:		COX, JAMESFACILITY TYPE:
775
ADDRESS:500 WEST NAPA STREETTELEPHONE:
(707) 524-6670
CITY:SONOMASTATE: CAZIP CODE:
95476
CAPACITY: 10CENSUS: 0DATE:
04/29/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:04 AM
MET WITH:James Cox, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:23 AM
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) Christi Coppo arrived unannounced to conduct a pre-licensing inspection and was greeted by Administrator, James Cox. Facility does not currently have participants.

At approximately 9:30am LPA and Administrator toured the building and grounds. The facility was found to be clean and at a comfortable temperature. Facility is located within Sonoma Market Shopping Center in suite 526. Suite is a one story one room suite with a bathroom and small utility closet where the water heater is located. Water temperature read at 110.8 degrees F which is within regulation of 105 & 120 degrees F. Cleaning supplies and toxins all located within a locked cabinet in the bathroom. All keys associated with facility are stored in a locked box on the wall, lock box is secured by a combination lock. All staff have combination in order to access keys.

Facility will be used for Adult Day Program. Facility to be primarily used as a drop-in center where participants can drop-in as needed. Staff will be present from 8:00am- 4:00pm. Snacks and drinks are stocked in the kitchen and will be provided if needed, but participants typically either bring their lunch or go out lunch. Kitchen is equipped with refrigerator, freezer, and coffee maker. Required posters present..

Fire clearance for eight [8] ambulatory and two [2] non-ambulatory granted, for a capacity of ten [10]. Facility sprinklers and smoke detector are hardwired and are inspected by Westside Mechanical Inc, Lic# 773449-C16. Last inspection report completed on 2/28/2024, noting two corrections needed. Corrections needed for two sprinkler heads too close to one another and one located too far off the wall. Per LPA review of inspection report, corrections completed 3/5/2024. Fire extinguishers last serviced 6/20/2023. Facility has First Aid kit; all required items present. Facility has AED.

Based on knowledge of Applicant, Component III is waived. Exit interview conducted with Administrator and a copy of this report given. LPA will submit facility's application for approval.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE: DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2024
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