Facility Evaluation Report

Licensing Program Analyst (LPA) Hansen conducted an announced pre-licensing inspection and was welcome by Property Manager Debbie Ahern-Colgrove, Director of Social Services for Council on Aging Renee Tolliver arrived shortly after. Fire clearance has been approved by Santa Rosa Fire Department for 15 non-ambulatory clients. Facility has no waiver requests at this time. Component III orientation has been waived by the RO. Facility will operate 5 days per week between 9:30am to 3:30pm.

LPA toured facility and observed: Facility is a two-floor building with 12 office spaces. This office space on the first floor contains one bathroom that all clients will use. The facility will have a phone designated for client use. Personnel records and client records will be stored in the facility office area.

During today’s visit LPA observed the following items:

Fire Extinguisher charged and serviced July 27, 2022

The water temperature was tested during inspection and was not within regulation of 105 – 120 Degrees F.