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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216803982
Report Date: 12/17/2021
Date Signed: 12/17/2021 01:49:54 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:ANTON POINTE, THEFACILITY NUMBER:
216803982
ADMINISTRATOR:ODIWE, CLEDA M.FACILITY TYPE:
740
ADDRESS:1470 SOUTH NOVATO BLVD.TELEPHONE:
(415) 897-1055
CITY:NOVATOSTATE: CAZIP CODE:
94947
CAPACITY:10CENSUS: 7DATE:
12/17/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Cleda Odiwe - Licensee/AdministratorTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Fernandes-Goes conducted a continue pre-licensing inspection and met with Licensee/Administrator Cleda Odiwe. This is a change of ownership. Fire clearance has been approved for 10 non-ambulatory residents by the County Fire Department. There is a total of 7 residents and no residents under Hospice care.

This is a continuation pre-licensing visit that occurred on 11/15/21. During today's tour of this facility 12/17/2021, the following pending items were observed:
- Facility is in in good repair: items that were requested to be fixed on 11/15/21 are in place at this time.
- Post the following: all necessary postings in place.
- Proof of quarterly disaster drill - on file during this visit.
- Request for underage resident exception - has been submitted and granted.

Pre-Licensing is complete and this facility has no apparent deficiencies. Facility is ready for licensure.

There were no deficiencies cited at this time.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Carla Fernandes-GoesTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
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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