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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486802037
Report Date: 03/26/2024
Date Signed: 03/26/2024 04:06:49 PM

Document Has Been Signed on 03/26/2024 04:06 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:A PLACE OF GRACE INC PADDON ROADFACILITY NUMBER:
486802037
ADMINISTRATOR:AMBER PALESIFACILITY TYPE:
735
ADDRESS:7428 PADDON RDTELEPHONE:
(707) 447-5676
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 6CENSUS: 4DATE:
03/26/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Roman Price, ManagerTIME COMPLETED:
04:10 PM
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Licensing Program Analysts (LPAs) Stefanie Mutialu and Jill Nakagawa arrived unannounced to conduct an inspection to follow up on some items from the Annual Inspection. LPAs made observations and found the facility to be clean and organized. Repairs to walls in hallways were not yet made, but they have been scheduled. Pictures of repairs will be forwarded to LPAs as soon as repairs have been completed.

No deficiencies were cited on this visit.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2024
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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