Facility Evaluation Report

Licensing Program Analyst (LPA) Cuadra, arrived unannounced to conduct an Annual Required Inspection and met with Site Coordinator, Annette Cutcomb. The program is open to participants Mondays and Wednesdays from 9:30 am to 2:00 pm. Required postings were observed. Contact information reviewed.

LPA initiated a tour of the facility at 9:10 am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. The activity schedule for the day was written on a white board. Meals are provided by Meals on Wheels. There are two common bathrooms available for participant use. Water temperature in bathroom measured at 114.1 degrees F which is within regulation. Bathrooms were equipped with grab bars to ensure safety. Toxins were inaccessible. Facility does not handle medications and does not provide transportation. Fire extinguisher was last inspected July, 2025. The smoke alarm system and fire extinguishers are maintained by the Sebastopol Senior Center. Most recent disaster drill was conducted 11/10/2025. Carbon monoxide was operational. Annual fees current.

LPA initiated file review at 9:50am: Two staff files and eight participant files were reviewed. Staff have required First Aid/CPR certificates and annual training hours. Participant's plan of cares and medical assessments were current.

Site Coordinator agreed to submit updates of the following documents by 12/29/2025: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500) and Lease agreement.

No deficiencies cited during today's visit. Exit interview conducted with Site Coordinator and copy of this report was given.