<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
216804022
Report Date:
04/28/2023
Date Signed:
04/28/2023 10:50:30 AM
Document Has Been Signed on
04/28/2023 10:50 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
CCLD Regional Office
,
1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA
,
CA
95405
FACILITY NAME:
OAKMONT OF NOVATO
FACILITY NUMBER:
216804022
ADMINISTRATOR:
PIELSTICK, RIC
FACILITY TYPE:
740
ADDRESS:
1465 S. NOVATO BLVD.
TELEPHONE:
(628) 215-1200
CITY:
NOVATO
STATE:
CA
ZIP CODE:
94947
CAPACITY:
118
CENSUS:
82
DATE:
04/28/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
10:00 AM
MET WITH:
Ric Pielstick
TIME COMPLETED:
11:00 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst Leibert arrived unannounced for the purpose of amending a case management and citation report that was issued on 4/6/2023 by LPA Cuadra. The report was amended and a copy left at the facility.
SUPERVISOR'S NAME:
Carla Martinez
TELEPHONE:
(707) 588-5059
LICENSING EVALUATOR NAME:
David Leibert
TELEPHONE:
(707) 588-5086
LICENSING EVALUATOR SIGNATURE:
DATE:
04/28/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
1