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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 236804078
Report Date: 07/06/2023
Date Signed: 07/06/2023 11:57:51 AM

Document Has Been Signed on 07/06/2023 11:57 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:MARIA ZOILA INCFACILITY NUMBER:
236804078
ADMINISTRATOR:BARLAHAN, ROSS EVAN P.FACILITY TYPE:
735
ADDRESS:48A WHITMORE LANETELEPHONE:
(707) 623-7770
CITY:UKIAHSTATE: CAZIP CODE:
95482
CAPACITY: 4CENSUS: 0DATE:
07/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Ross Evan BarlahanTIME COMPLETED:
12:15 PM
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At approximately 11:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility to conduct an unannounced Annual Required inspection. LPA met with Administrator Ross Evan Barlahan and toured the building. There are no clients currently residing at the facility. Administrator will notify CCL when they accept their first client.

The home was clean and in good repair. All fire extinguishers were charged. Smoke detectors were tested and in working order. Carbon monoxide detector was present.

LPA reviewed Administrator file and found First aid and CPR certification was current.

Administrator will submit an updated facility sketch, showing the new permitted room additions to CCL. Upon receipt, LPA will request an updated fire clearance.

No citations issued during this visit.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2023
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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