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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286803356
Report Date: 12/03/2024
Date Signed: 12/03/2024 11:17:01 AM

Document Has Been Signed on 12/03/2024 11:17 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:CORE ARF GADWALLFACILITY NUMBER:
286803356
ADMINISTRATOR/
DIRECTOR:
DADO,MYLENEFACILITY TYPE:
735
ADDRESS:3 GADWALL COURTTELEPHONE:
(707) 554-4802
CITY:AMERICAN CANYONSTATE: CAZIP CODE:
94503
CAPACITY: 2CENSUS: 1DATE:
12/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Mylene DadoTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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At approximately 9:30AM, Licensing Program Analyst (LPA) Chris Arnhold conducted an unannounced Annual Required inspection at this facility and met with Administrator Mylene Dado. At approximately 9:45AM, LPA toured the building and grounds which was found to be clean and in good repair. LPA 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 client. 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 client. Fire extinguishers inspected were charged. Smoke detectors were found to be in working order. Carbon Monoxide detector was present. Facility has fire sprinklers throughout. Disaster Drills are conducted monthly.
At approximately 10:30AM, LPA reviewed 1 of 1 Client records and 3 of 3 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. Administrator's Certificate was current with an expiration date of 02/14/2025.

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: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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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