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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803926
Report Date: 09/26/2024
Date Signed: 09/26/2024 12:56:30 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/26/2024 12:56 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:EVAS CARE HOMEFACILITY NUMBER:
486803926
ADMINISTRATOR:MULDER, EVAFACILITY TYPE:
740
ADDRESS:319 ATLANTIC AVETELEPHONE:
(510) 890-8777
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:6CENSUS: 0DATE:
09/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Eva Mulder, LicenseeTIME COMPLETED:
01:00 PM
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At approximately 11:20 AM, Licensing Program Analyst, (LPA) Julie Florio arrived unannounced for the purpose of conducting a required 1-year annual inspection. LPA received no answer at the front door and observed no vehicles present at the facility. LPA contacted Eva Mulder, Licensee via telephone and was informed that there are no residents in care at the facility and there have not been any in care since December 2023. LPA was informed that Licensee wishes to close the facility and plans to rent the home out. Licensee arrived at approximately 11:50 AM to conduct a closure inspection pursuant to voluntary closure of this licensed Residential Care Facility for the Elderly (RCFE) . The purpose of the inspection is to confirm the licensed program services have been discontinued and verify that there are no residents in care.

At approximately 12:00 PM, LPA conducted a walk-through of the facility, inspected all rooms and the exterior of the home. LPA confirmed there are currently no residents receiving services and the facility is vacant with only a kitchen table inside the home and some bedroom furniture in the garage. No other items were present in the facility. Licensee informed LPA that they no loner wish to operate a care facility because of the challenges with obtaining residents, the costs associated with working with referral agencies and staffing issues. Licensee states they are currently working with a property management company to get the home rented out. LPA informed Licensee of the need to notify Community Care Licensing (CCL) in writing of their intent to close the facility and provided Licensee with LPA's email address to do so. Licensee understands.

Closure inspection of this facility has been completed. Facility surrendered the license to LPA, and all postings have been removed. Upon receipt of written notification from Licensee, The Department will move forward with the closure process. LPA to finalize paperwork for final closure.

No deficiencies cited during today's visit.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Julie FlorioTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2024
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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