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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286803898
Report Date: 01/31/2024
Date Signed: 01/31/2024 11:34:09 AM


Document Has Been Signed on 01/31/2024 11:34 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:PINK LADY CAREHOME, LLC.FACILITY NUMBER:
286803898
ADMINISTRATOR:CECILE MENDOZAFACILITY TYPE:
740
ADDRESS:39 VIA MARCIANATELEPHONE:
(707) 731-1842
CITY:AMERICAN CANYONSTATE: CAZIP CODE:
94503
CAPACITY:6CENSUS: 0DATE:
01/31/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Jean Felix, LicenseeTIME COMPLETED:
11:30 AM
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An Informal meeting was conducted today in the Santa Rosa Regional Office. Present in the meeting were Licensing Program Manager (LPM) Kimberley Mota, Licensing Program Analyst (LPA), Araceli Canela and Licensee, Jean Felix. The purpose of the Informal meeting was to address concerns during an inspection of 1/17/2024. Items addressed in today's meeting include but are not limited to compliance issues outlined below:

· Licensee to ensure all utilities and/or items needed to run the facility, for the comfort and safety of the residents are paid on time.

· Licensee to ensure the facility has a current Administrator or submits and notifies Community Licensing in writing when there is a change in Administrator.

· Licensee to ensure all new staff are properly associated and have a fingerprint clearance prior to working, living or volunteering in this facility.



No citations issued during todays informal meeting.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Araceli CanelaTELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2024
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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