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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216803891
Report Date: 09/05/2023
Date Signed: 09/05/2023 01:59:12 PM


Document Has Been Signed on 09/05/2023 01:59 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:MARIN TERRACEFACILITY NUMBER:
216803891
ADMINISTRATOR:THOMAS EISEMANFACILITY TYPE:
740
ADDRESS:297 MILLER AVETELEPHONE:
(415) 388-9526
CITY:MILL VALLEYSTATE: CAZIP CODE:
94941
CAPACITY:49CENSUS: 24DATE:
09/05/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:43 PM
MET WITH:Erlinda Ferris (Executive Director)TIME COMPLETED:
02:14 PM
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Licensing Program Analysts (LPAs) Cuadra and Coppo arrived unannounced to the facility to conduct a case management visit to follow up on an Application form received at CCL and met with Executive Director, Erlinda Ferris.

On 8/16/23 CCL received an Application form (LIC200) indicating their intention to downsize their capacity from 49 to 39 residents. Per conversation with Dinesh Sawhney, they are in the process of applying for a license for the other building located in the back of the property. In the meantime, they want to hold off any further step until they get licensed, and want to keep same capacity of 49 residents. LPAs advised them that when they are ready to downsize a new facility sketch needs to be submitted to CCL to obtain an updated fire clearance along with $25 license fee, and any addendums to plan of operation addressing safety issues, staffing, activities, food service or any area of the operation that may be impacted by a change of capacity. Executive Director agreed that this list may expand as the Department evaluates further needs.

No citations issued during today's visit.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:
DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2023
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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