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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
230108719
Report Date:
08/05/2024
Date Signed:
08/05/2024 11:36:19 AM
Document Has Been Signed on
08/05/2024 11:36 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO
,
1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA
,
CA
95405
FACILITY NAME:
MENDOCINO COLLEGE CHILD CARE FACILITY
FACILITY NUMBER:
230108719
ADMINISTRATOR:
JANIS WOOD
FACILITY TYPE:
850
ADDRESS:
1000 HENSLEY CREEK ROAD
TELEPHONE:
(707) 468-3089
CITY:
UKIAH
STATE:
CA
ZIP CODE:
95482
CAPACITY:
57
CENSUS:
0
DATE:
08/05/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
10:24 AM
MET WITH:
Susan Sopp
TIME COMPLETED:
11:49 AM
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Licensing Program Analyst (LPA) Robert Maciel made an unannounced case management visit and met with facility representative Susan Sopp for the purpose of obtaining more information about an unusual incident report submitted to the department on 7/30/24.
LPA interviewed staff and adults.
No deficiencies were cited during today's inspection. A notice of sight visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME:
Alexis Hollon
TELEPHONE:
(707) 588-5036
LICENSING EVALUATOR NAME:
Robert Maciel
TELEPHONE:
(707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE:
08/05/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/05/2024
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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