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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486801461
Report Date: 10/15/2019
Date Signed: 07/14/2023 05:40:38 PM

Document Has Been Signed on 07/14/2023 05:40 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
,
, CA
FACILITY NAME:DANA'S FAMILY HOMEFACILITY NUMBER:
486801461
ADMINISTRATOR:THOMAS, DANAFACILITY TYPE:
735
ADDRESS:855 PALERMO DR.TELEPHONE:
(707) 438-7397
CITY:SUISUNSTATE: CAZIP CODE:
94585
CAPACITY: 4CENSUS: 3DATE:
10/15/2019
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
04:53 PM
MET WITH:Dana Thomas, LicenseeTIME COMPLETED:
05:25 PM
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Licensing Program Analyst (LPA) K. Canela arrived here on 10/15/2019 for the purpose of conducting an Annual Required inspection. LPA arrived at 3:10 PM and knocked on the door and rang the doorbell but no one answered the door. LPA called facility phone number and Licensee's phone number but no one answered. LPA could hear the phone ringing inside and a client making noises. LPA observed no staff car present at the facility and did not hear staff present. LPA waited outside the facility during this duration.

LPA contacted non-emergency police to request a welfare check for clients in care. LPA was granted access into facility by Loretta Blair, caregiver, at 4:53 PM when police arrived. Caregiver stated she did not hear the phone, doorbell, or door knocking from LPA. Caregiver stated she was giving clients showers and could not hear LPA.
At 5:07 PM Dana Thomas, Licensee, arrived to facility.

Due to time restraint, LPA will return to facility to continue Annual inspection.

No deficiencies cited during today's inspection.
SUPERVISORS NAME: Carla Martinez
LICENSING EVALUATOR NAME: Karina Canela
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2019
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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