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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577003619
Report Date: 08/22/2024
Date Signed: 08/22/2024 04:24:01 PM

Document Has Been Signed on 08/22/2024 04:24 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:SAFE HARBOR CRISIS HOUSE-YOLO COMMUNITY CAREFACILITY NUMBER:
577003619
ADMINISTRATOR/
DIRECTOR:		WATSON, SHARONDAFACILITY TYPE:
772
ADDRESS:584 KENTUCKY AVENUETELEPHONE:
(530) 661-3213
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY: 14CENSUS: 8DATE:
08/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:05 PM
MET WITH:Sharonda Watson, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 08/22/2024, Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an Annual Inspection. There are currently 8 residents at the facility.

LPA was met at the door by staff and logged in. Sharonda Watson, Administrator met LPA and toured the facility. Facility was clean and orderly, and a comfortable temperature. Residents' rooms were clean and had the required furnishings. Bathrooms were clean and sanitary, and equipped with new shower curtains, grab bars, non-slip mats and supplied with paper towels and hand soap. Hot water measured within regulation. Fire extinguishers were last serviced on 02/09/2024. New fire panel was installed 07/24/2024. Medications and sharps were locked and inaccessible to residents. The kitchen had an ample supply of perishable and non-perishable food and snacks available at all times. The kitchen floor requires repairs due to cracked and peeling floor tiles.
Residents enjoy the comforts of the living room, watching a large screen TV, listen to music, accessing the computer time. Residents can enjoy the back patio and play basketball and corn hole. There is also an area set up for arts and crafts, music and lots of reading materials. The facility also provides a private visitation area and an on-site counselor. Staff are receiving monthly training through Health Stream.

A review of 5 resident and 5 staff files found them to be complete.

LPA requested updated copies of the LIC 500, Control of Property, Liability Insurance.

There were no deficiencies found at the time of this inspection.
No citations issued.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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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