<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 236803321
Report Date: 01/17/2025
Date Signed: 01/17/2025 01:05:40 PM

Document Has Been Signed on 01/17/2025 01:05 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:ENHANCED SERVICESFACILITY NUMBER:
236803321
ADMINISTRATOR/
DIRECTOR:		BASHAW, SEANFACILITY TYPE:
775
ADDRESS:915 S. DORATELEPHONE:
(707) 489-1513
CITY:UKIAHSTATE: CAZIP CODE:
95482
CAPACITY: 40CENSUS: 9DATE:
01/17/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:25 AM
MET WITH:Sean Bashaw, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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
On 01/17/2025, at approximately 10:25 AM, CCLD staff, Licensing Program Analysts (LPAs) Julie Florio and Ali Deniz arrived unannounced to conduct a Case Management - Other visit for the purpose of inspecting the facility to help the Department determine if the day program can be converted into an emergency shelter in the event a natural disaster were to occur in the area. LPAs met with Administrator Sean Bashaw.

At approximately 10:45 AM, LPAs toured the day program with Administrator. LPAs' observations and discussions with Administrator documented on LIC812s. Further discussion will occur between the Regional Centers and the Department of Developmental Services. Licensee will be notified once a decision is made.

No deficiencies cited during today's visit.

Exit interview conducted with Administrator whose signature on form confirms receipt of documents.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2025
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