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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216800849
Report Date: 02/26/2025
Date Signed: 02/26/2025 01:07:11 PM

Document Has Been Signed on 02/26/2025 01:07 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:CEDARS DANTE HOUSEFACILITY NUMBER:
216800849
ADMINISTRATOR/
DIRECTOR:
MAYEEN GALANGFACILITY TYPE:
740
ADDRESS:1914 NOVATO BLVDTELEPHONE:
(415) 897-0817
CITY:NOVATOSTATE: CAZIP CODE:
94947
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
02/26/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Administrator Mayeen GalangTIME VISIT/
INSPECTION COMPLETED:
01:16 PM
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Licensing Program Analysts (LPAs) Deniz and Loera arrived unannounced at approximately 9:15AM to conduct an Annual Required inspection and was greeted by staff. LPAs and staff discussed the purpose of the visit. Administrator, Mayeen Galang arrived shortly after.

LPAs and staff initiated a tour of the facility around 09:35 AM and made the following observations: Facility was a comfortable temperature, and passageways were free from obstructions except room one. LPAs observed a bench located on the outside blocking the exit passageway in room one, Administrator removed bench from passageway (Technical Violation issued). Resident rooms were furnished per regulation. Water temperature in sinks accessible to clients measured at 108 degrees F which is within the range of 105 to 120 degrees F allowed per regulation.

Extra hygiene products and linens were available. Cabinets containing cleaning supplies were locked. Facility has at least two days of perishable and one week of non-perishable foods which were of quality and stored per regulation. Medications were centrally stored and locked. Emergency food and water is stored in the garage. LPAs discussed with administrator Mayeen about emergency water and food supply to be fully stocked per Title 22. Administrator agrees and will make sure the facility fully stocked for emergency needs. Personal Protective Equipment is stored in the garage.


Fire extinguishers were last serviced 02/2025. Facility smoke and carbon monoxide detectors located throughout the facility were tested and operational during inspection. Most recent fire/disaster drill was conducted 01/05/2025. Client cash resources were reviewed. Four staff files and four resident files were reviewed. Staff have required First Aid and CPR certificates. Medications and medication records were reviewed. Administrator Certificate for Administrator, Mayeen Galang (6029937740) expired 02/24/2025, but she applied for renewal.

Continued on LIC809C
Victoria BertozziTELEPHONE: (707) 588-5059
Ali DenizTELEPHONE: (707) 588-5087
DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: CEDARS DANTE HOUSE
FACILITY NUMBER: 216800849
VISIT DATE: 02/26/2025
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Continued from LIC809

Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on forms confirms receipt of documents.

LPA is requesting the following documents to be submitted to Community Care Licensing by 03/26/2025:

LIC 500 Personnel Report

LIC 308 Designation of facility responsibility
Updated Liability Insurance
Emergency Disaster Plan (Review and update if need it)
SUPERVISOR'S NAME: Victoria BertozziTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Ali DenizTELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025
LIC809 (FAS) - (06/04)
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