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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804253
Report Date: 01/10/2025
Date Signed: 01/10/2025 11:30:04 AM

Document Has Been Signed on 01/10/2025 11:30 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:SOUTHWEST DAY PROGRAMFACILITY NUMBER:
496804253
ADMINISTRATOR/
DIRECTOR:
GALANG, MARY CLEINFACILITY TYPE:
775
ADDRESS:205 SOUTHWEST BLVD.TELEPHONE:
(650) 866-9367
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 45CENSUS: 0DATE:
01/10/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Maribeth Lucero-Applicant/LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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Licensing Program Analyst, Alviso, conducted a pre-licensing inspection, on 1/10/25 at approximately 9:00am, and met with Applicant/ Licensees, Maribeth Lucero,, Nemia Atendido, Mona Rojas, and hired Administrator, Mary Clein Galang. LPA conducted a component III orientation with hired Administrator Mary Clein Galang, today, 1/10/25.
Facility has an approved fire clearance for forty-five (45) non-ambulatory capacity, effective 9/26/24. Facility has a required infection control plan, and a required emergency disaster plan.
LPA toured the facility with all Applicant/Licensees, and hired Administrator. Hot water was checked at
105. degrees Fahrenheit. Administrator agreed to ensure the hot water stays within regulation compliance of no lower than 105. degrees, and no higher than 120. degrees, Fahrenheit. All exits were clear of obstruction and had exit auditory alarms that worked properly during the inspection. Fire extinguishers, two (2), were serviced and tagged as required. All smoke alarms were in place, and were cleared as working properly. The facility has nine (9) carbon monoxide detectors that worked properly during the inspection. The facility has two bathrooms that have grab bars and sufficient lighting for client use. There is a conference/library room, an office room, and a kitchen/break room. There is a room that will be used as a client rest area/ calm quiet area, and sick room if needed. The facility has a small spa room for use by clients. There is a cleaning/changing room for use to provide needed services to clients in care; Applicants have ordered privacy screens for this room as needed/required for clients receiving personal care services. The facility has a large room for use of daily day program classes/art/television/ projects/ lunch room use by all clients in care. There was sufficient furnishings in place, and all common areas/rooms/bathrooms had sufficient lighting. There were activity games and miscellaneous art/game products stored in the activity closet. A locked cabinet for centrally storing and locking up medications as required. A locked storage room for supplies, and locking up cleaners/disinfectants as required. There is a laundry set on-site for use as needed, housed in the kitchen area. There are several cabinets throughout the facility for locking and securing items that may pose a risk to clients in care as needed/required.

LPA did not observe any health and safety concerns that would hold up licensure of the facility once the application is complete. LPA will forward the facility inspection report to the application unit in Sacramento. Application unit analyst will notify applicants regarding the application status.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2025
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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