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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286803093
Report Date: 06/26/2023
Date Signed: 06/26/2023 10:58:21 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/26/2023 10:58 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:RMB HOME CARE, INC.FACILITY NUMBER:
286803093
ADMINISTRATOR:BELLOSILLO, MARINELLEFACILITY TYPE:
740
ADDRESS:6 VIA PESCARATELEPHONE:
(707) 553-8139
CITY:AMERICAN CANYONSTATE: CAZIP CODE:
94503
CAPACITY:6CENSUS: 0DATE:
06/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator, Marinelle BellosilloTIME COMPLETED:
11:07 AM
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Licensing Program Analyst Bertozzi arrived unannounced to conduct an Annual Inspection and met with Licensee, Marinelle Bellosillo.

Facility does not currently have any residents in care. LPA conducted a walk through of the facility and confirmed that there are currently no residents in care. Facility does not have a current plan to admit residents but will contact CCL if they choose to admit any new residents so LPA can conduct a visit prior to move-in.

No deficiencies cited during this inspection.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria BertozziTELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:
DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/26/2023
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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