Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek conducted a Pre-Licensing Inspection with Applicant Representative Crystal Goodwin and Administrator Jep Stokes. An Application to operate a Social Rehabilitation Facility (SRF) was received by Community Care Licensing (CCL) on 03/10/2021. A Fire Clearance was approved for a maximum capacity of six (6) ambulatory residents on 06/07/2021.

The proposed physical plant is a two (2) story single family dwelling located in a residential neighborhood of Santa Rosa Valley, CA. A tour of the physical plant was conducted and the following observed:

KITCHEN: Appliances and fixtures appeared clean and functional. There was sufficient nonperishable food to accommodate a maximum capacity of 6 Clients for (seven) 7 days. There was sufficient dining and cook ware to accommodate a maximum capacity of 6 Clients. Cleaning supplies will be stored in locked under-sink cabinets. Knives and other sharps will be stored in a locked cabinet. There were no visible immediate hazards observed.

BEDROOMS: There are three (3) Bedrooms, all of which are designated for Resident use. All bedrooms are located on the second story and furnished for double occupancy. All bedrooms were equipped and supplied with appropriate furniture, bedding and linens. There were no visible hazards or discrepancies observed.

BATHROOMS: There are six (6) Bathrooms, two (2) on the ground floor and four (4) on the second floor. The bathrooms located on the ground floor include a half bath in the main hallway for client use and a full bath attached to the office designated for staff use. The bathrooms located on the second floor are all full bathrooms and are three (3) designated for client use. 1 upstairs bathroom is designated for staff use only. All Bathrooms were supplied with appropriate paper and hygiene products. COVID-19 signs are required inside all bathrooms and were observed during the visit. Water temperatures were measured in Report Continued on LIC 809-C