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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803525
Report Date: 03/29/2023
Date Signed: 07/03/2023 08:17:02 AM

Document Has Been Signed on 07/03/2023 08:17 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:DARWIN FACILITYFACILITY NUMBER:
486803525
ADMINISTRATOR:HALL, MYRTLEFACILITY TYPE:
735
ADDRESS:1612 TUCSON CIRCLETELEPHONE:
(707) 426-4981
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY: 4CENSUS: 2DATE:
03/29/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Myrtle Hall, LicenseeTIME COMPLETED:
12:00 PM
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On 3/29/2023, Licensing Program Analyst Tobola and Licensing Program Manager, Hope DeBenedetti conducted a virtual informal office meeting with Licensee, Myrtle Hall and Lead Staff, Joanna Hall. North Bay Regional Center staff, Thomas Brungardt and Caitlin Igoe were also in attendance.

The CCLD discussed historic concerns within the facility with Licensee. Concerns over Licensee and staff availability from attempted facility visits and telephone contact difficulties were addressed. Licensee explained current availability and scheduling in the facility and provided CCLD and NBRC with updated phone and email contact information. Lead Staff, Joanna Hall stated that they will be the primary contact to reach in case of visits and inquiries. Licensee agrees to ensure appropriate availability and timely contact with CCLD and NBRC to remain in compliance.

In addition, CCLD addressed past bedbug infestations and status updates on the services. Facility is currently receiving continuous exterminator services with the facility requiring spraying service every several weeks. Licensee stated that the services require all staff and clients to be outside of the facility for several hours until completed. Licensee agrees to follow develop plan in which the Licensee agrees to provide CCLD and NBRC with the most recent and all upcoming service records from exterminator indicating plans for monitoring and completion. Licensee also agrees to submit in writing, the facility's plan to address and monitor bedbugs in the facility to ensure the health and safety of the clients in care.

No deficiencies cited during today's visit.
LPA provided electronic copy to Licensee for signature. Signature on file.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2023
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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