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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803946
Report Date: 02/05/2021
Date Signed: 07/27/2023 11:16:40 AM


Document Has Been Signed on 07/27/2023 11:16 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928



FACILITY NAME:PARKSIDE MANORFACILITY NUMBER:
486803946
ADMINISTRATOR:GANZON, CECILIAFACILITY TYPE:
740
ADDRESS:50 CADLONI LNTELEPHONE:
(707) 246-2754
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:17CENSUS: 0DATE:
02/05/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:59 PM
MET WITH:Cecilia GanzonTIME COMPLETED:
01:30 PM
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Regional Manager, Carla Nuti-Martinez, Licensing Program Manager, Bethany Moellers and Licensing Program Analyst (LPA) Araceli Canela made contact on this date, via tele-visit, with Applicants/Licensee Cecilia Ganzon, Aurelia Renta and House manager Emilio Manio to conduct this Case Management visit and discuss this new Change in Ownership Application for Parkside Manor, # 486803946 that was submitted due to Application changes and additional members.
Prior to this application the facility Parkside Manor #480110389 was placed on Non-Compliance plan for two years on November 5, 2020 by the Department and was notified it is subject to increased quarterly monitoring to ensure compliance. Failure to comply with the terms and conditions of the compliance plan may result in administrative action.

The purpose of this meeting is to notify applicants, Cecilia Ganzon and Aurelia Renta that upon licensure of Parkside Manor, # 486803946. The Non-Compliance plan will carry over to this new facility once they receive licensure.

SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Araceli CanelaTELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:
DATE: 02/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/05/2021
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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