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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577005397
Report Date: 11/09/2023
Date Signed: 11/09/2023 12:03:47 PM

Document Has Been Signed on 11/09/2023 12:03 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:HARMONY DAY PROGRAMFACILITY NUMBER:
577005397
ADMINISTRATOR:VENTIMIGLIA, DOMINICFACILITY TYPE:
775
ADDRESS:1250 HARTER AVE, STE GTELEPHONE:
(530) 666-6146
CITY:WOODLANDSTATE: CAZIP CODE:
95776
CAPACITY: 30CENSUS: 17DATE:
11/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Patty Mendoza, Program ManagerTIME COMPLETED:
12:05 PM
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Licensing Program Analyst (LPA) Jill Nakagawa conducted an unannounced Annual Required – 1 yr. inspection to this facility and met with Patty Mendoza, Program Manager. There were 17 clients present at the facility and 5 staff members and the program manager..

LPA arrived at the facility and had temperature checked and logged into visitor’s binder. During facility tour on 11/09/23 with Patty Mendoza, program manager; facility was found to be clean and at a comfortable temperature of 71 F with all exits free from obstruction. Clients' common areas, kitchen & food storage areas were inspected and found to be clean and sanitary. Clients bring their own lunches each day, which are stored in kitchen area. Staff warm them up and help serve on trays which are wrapped and labeled. Two (2) Fire Extinguishers were found to be charged on 08/14/23. Smoke detectors, carbon monoxide detectors and fire sprinkler system was last inspected on 07/31/23. There was a supply of cleaners, hygiene products and other toxins which were stored in a locked cabinet under the kitchen sink and in a locked storage cabinet. Medications and sharps are kept in a locked med cart in the med room area. There are 2 client bathrooms set up with hoyer lifts and large changing tables, which were found to be clean and sanitary. There are also 2 staff restrooms, with a supply of soap and paper towels. Water temperature in each bathroom measured 109 F. The large Activity Room is supplied with many activities and comfortable seating to accommodate the special needs of the clients. There is also an enclosed outside activity area with tables and a swing that can accommodate a wheelchair.
There were no deficiencies found at the time of inspection. No citations issued.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2023
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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