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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 236801842
Report Date: 12/13/2024
Date Signed: 12/13/2024 12:08:05 PM

Document Has Been Signed on 12/13/2024 12:08 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:CARING HOME, LLCFACILITY NUMBER:
236801842
ADMINISTRATOR/
DIRECTOR:
ARNOLD, DONNAFACILITY TYPE:
735
ADDRESS:210 BONNIE LANETELEPHONE:
(707) 459-9425
CITY:WILLITSSTATE: CAZIP CODE:
95490
CAPACITY: 6CENSUS: 4DATE:
12/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Raymond DulinskyTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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At approximately 9:45AM, Licensing Program Analyst's (LPA's) Star Stevenson and Chris Arnhold conducted an unannounced Annual Required inspection to this facility and met with Raymond Dulinsky. At approximately 10:15AM, LPA's toured the building and grounds which was found to be clean and in good repair. LPA's observed all walkways and exits to be unobstructed. The amount of fresh and non-perishable foods was within regulation. Toxins are secure and not accessible to clients. Medication is centrally stored and secure. There is a sufficient supply of hygiene products and linens on hand for client use. Mattress pads were in place or available for Client use. Water temperature measured within regulation between 105 and 120 degrees F at faucets accessible to clients. Fire extinguishers inspected were charged. Smoke detectors were tested and found to be in working order. Carbon Monoxide detector was present. Disaster Drills are conducted monthly with the last drill conducted 12/3/2024.

At approximately 10:45AM, LPA's reviewed 4 of 4 Client records and 4 Staff records, which were all found to be well organized, thorough and contained the required documentation. First aid certification was current in staff files reviewed. P&I monies were documented, secure and not commingled.

LPA requested the following documents to update the facility file:
Current lease agreement or evidence of control of property
LIC500- Personnel Report
LIC610D- Disaster Plan

No deficiencies were observed in the areas inspected. No citations issued during today’s visit.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2024
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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