496804253-1-25-2026-21-AS-DALO-DQP9BE-20260125221322

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 496804253
Report Date: 01/20/2026
Date Signed: 01/25/2026 10:13:51 PM

Document Has Been Signed on 01/25/2026 10:13 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:	SOUTHWEST DAY PROGRAM		FACILITY NUMBER:	496804253
ADMINISTRATOR/ DIRECTOR:	GALANG, MARY CLEIN		FACILITY TYPE:	775
ADDRESS:	205 SOUTHWEST BLVD.		TELEPHONE:	6508669367
CITY:	ROHNERT PARK	STATE: CA	ZIP CODE:	94928
CAPACITY: 45		CENSUS: 19	DATE:	01/20/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Mary Galang-Administrator		TIME VISIT/ INSPECTION COMPLETED:	01:30 PM

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) Alviso conducted a Required - 1 Year inspection, on 1/20/26 at approximately 9:15am, and met with Administrator Mary Galang. Facility has a fire clearance approval for a total of forty-five (45) non-ambulatory clients. The facility has a required infection control plan. The facility has a required emergency disaster plan. Per review, last emergency disaster drills were conducted on,12/15/25, shelter in place, and 9/25/25, active shooter. The count of today's client participants was noted at nineteen (19) during LPA'a inspection. Today there are ten (10) staff working at the program today. The day program operates Monday through Friday, 8:00am to 4:00pm. Day program has a transportation van for outings. Clients are transported to and from day program by R&B transportation and/or by family. LPA reviewed six (6) client files. Client files were complete. LPA reviewed six (6) staff files. All staff have criminal record clearance as required. LPA reviewed staff training. All staff have first aid certification and CPR certification. LPA toured the facility with the Administrator. The fire extinguishers were fully charged and tagged; Administrator stated that the company that inspects the fire extinguishers would be contacted to do the yearly service. LPA observed arts/crafts supplies, television for movies/music, and miscellaneous games for use by clients. The facility was observed to be at a comfortable temperature. The carbon monoxide detector was observed to be working appropriately during the inspection. All exits were free and clear of obstructions. All appliances in the kitchen area were working appropriately during the inspections. Tools, scissors, knives, and other items that may be a risk to clients in care, were locked up and inaccessible. Continued on LIC809C...

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Dina Alviso
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/20/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2026

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: SOUTHWEST DAY PROGRAM	FACILITY NUMBER: 496804253
	VISIT DATE: 01/20/2026

NARRATIVE

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All medications were locked and inaccessible to clients in care; Cleaners/disinfectants were locked and inaccessible to clients in care. Facility had an emergency food supply; LPA discussed ensuring supplies to meet clients enrolled in services and staff on the schedule, ensuring sufficient water supply for all individuals, for drinking and preparing meals if needed in an emergency. Sufficient supply of paper products, soap, cleaners/disinfectants, sanitizer, and personal protective equipment (PPE) for use as needed. There was sufficient furnishings for client use.

Licensee to submit the following annual forms by 2/20/26:
LIC500- Personnel Report (ensure Administrator is on-site minimum of 20 hours Monday-Friday)
LIC308- Designation of Responsibility
LIC610D- Emergency Disaster Plan- 9pg - (review & update as needed--submit if changes)
LIC400-Affidavit Regarding Client Cash Resources
LIC402-Surety Bond (if handling client cash)
Infection Control Plan- (review & update as needed--submit if changes)
Copy of Administrator Certificate

The following deficiency was observed during the inspection:
Hot water was measured at 125.4 degrees Fahrenheit, in a facility bathroom used by the clients; The measured temperature of 125.4 degrees is not in compliance with regulation of "no higher than 120. degrees, and no lower than 105. degrees, Fahrenheit. Deficiency cited, 82088(e)(1) Fixtures, Furniture, Equipment, and Supplies- Faucets used by clients for personal care shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C), see LIC809D.

Deficiency 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 Administrator Mary Galang. Appeal Rights provided to the staff.

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Dina Alviso
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/20/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/25/2026 10:13 PM - It Cannot Be Edited

Created By: Dina Alviso On 01/20/2026 at 01:05 PM

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: SOUTHWEST DAY PROGRAM	FACILITY NUMBER: 496804253
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/20/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

82088(e)(1)

Fixtures, Furniture, Equipment, and Supplies

(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's observation, hot water was measured at 125.4 degrees Fahrenheit, in a facility bathroom used by the clients; The measured temperature of 125.4 degrees is not in compliance with regulation of "no higher than 120. degrees, and no lower than 105. degrees, Fahrenheit, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 01/21/2026
	Plan of Correction
1 2 3 4	Licensee/Administrator to ensure the hot water heater is turned down, monitor the hot water to ensure it drops down to within regulation compliance measurement, no lower than 105. degrees, and no higher than 120.degrees, Fahrenheit. Obtain the ability to automatically regulate temperature of hot water delivered to plumbing fixtures to ensure compliance of hot water temperature, per regulation. Submit how the facility will correct this deficiency, and submit a hot water log by 1/27/26. POC due 1/21/2026.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 01/20/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2026

LIC809 (FAS) - (06/04)

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