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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 125000567
Report Date: 12/09/2024
Date Signed: 12/09/2024 01:36:53 PM

Document Has Been Signed on 12/09/2024 01:36 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:FIRST CHOICE CARE HOMEFACILITY NUMBER:
125000567
ADMINISTRATOR/
DIRECTOR:
POPA-ROOP, NADIAFACILITY TYPE:
740
ADDRESS:456 10TH STREETTELEPHONE:
(707) 725-7899
CITY:FORTUNASTATE: CAZIP CODE:
95540
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 9DATE:
12/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Nadia Popa-RoopTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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At approximately 11:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Required-1 Year inspection. LPA met with Administrator Nadia Popa-Roop and explained the purpose of the visit. Administrator certificate is current. LPA toured the facility to ensure the health and safety of residents in care. Areas toured include but are not limited to resident rooms, common areas, bathrooms, kitchen, storage areas and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. The common areas, bathrooms and kitchen were clean and in good repair. All bedrooms had required furniture, bedding, and lighting. Cooking/dining equipment and utensils were present. Food appears to be stored and prepared properly. Facility has required seven-day non-perishable and two day perishable supply of food. Medication is locked and not accessible. The facility was observed to be at a comfortable temperature. First aid kit was present. Fire extinguishers were fully charged. Smoke detectors are all operational. Facility has a fire sprinkler system. Carbon Monoxide Detector was present. All employees requiring background checks are cleared. No pools/bodies of water are on the premises. Facility has been conducting drills monthly.

At approximately 11:45AM, LPA reviewed Staff and resident files. All resident files contained the required documentation. Staff files reviewed contained evidence of completed annual training. First Aid/CPR certification was current.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit:



Evidence of Liability Insurance


No deficiencies were observed in the areas inspected, No citations were issued during today’s visit.
Bethany MoellersTELEPHONE: (707) 588-5040
Christopher ArnholdTELEPHONE: (707) 588-5084
DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2024
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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