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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216803982
Report Date: 11/30/2023
Date Signed: 11/30/2023 10:35:25 AM


Document Has Been Signed on 11/30/2023 10:35 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: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: 8DATE:
11/30/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Administrator, Cleda OdiweTIME COMPLETED:
10:40 AM
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At approximately 9:20 Licensing Program Analysts (LPAs) Helena Rummonds and Caitlynn Felias arrived unannounced to conduct a case management inspection. LPA was greeted by Administrator, Cleda Odiwe, and discussed the purpose of the visit.

LPAs returned to the facility for the purpose of amending a document from a visit dated 11/02/2023. This document requires amending due to the use of the improper civil penalty form. LPA is also following up on a death report dated 10/26/2023 that was received by CCL on 11/20/2023. This was received by Community Care Licensing (CCL) over the 7 days as required by regulation 87211 (Technical Violation issued, see LIC9102).

No deficiencies cited during visit.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Helena RummondsTELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2023
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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