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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803305
Report Date: 04/11/2023
Date Signed: 04/11/2023 12:22:06 PM

Document Has Been Signed on 04/11/2023 12:22 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:PACE WINERY SQUAREFACILITY NUMBER:
486803305
ADMINISTRATOR:BRITTANY MCEWENFACILITY TYPE:
775
ADDRESS:1955 W TEXAS ST STE 190TELEPHONE:
(707) 426-6932
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 75CENSUS: 62DATE:
04/11/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
11:39 AM
MET WITH:Brittany McEwen, AdministratorTIME COMPLETED:
12:31 PM
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Licensing Program Analyst (LPA) Karina Canela arrived unannounced for the purpose of conducting a collateral visit and met with Brittany McEwen, Administrator.

LPA conducted interviews to obtain additional information regarding complaint number: 21-AS-20230407164133

No deficiencies cited during today's visit.

This report was emailed to Administrator
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Karina Canela
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2023
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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