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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803946
Report Date: 03/26/2024
Date Signed: 03/26/2024 10:35:06 AM


Document Has Been Signed on 03/26/2024 10:35 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:PARKSIDE MANORFACILITY NUMBER:
486803946
ADMINISTRATOR:GANZON, CECILIAFACILITY TYPE:
740
ADDRESS:50 CADLONI LNTELEPHONE:
(707) 557-8991
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:17CENSUS: 14DATE:
03/26/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:19 AM
MET WITH:Cecilia Ganzon, LicenseeTIME COMPLETED:
10:31 AM
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Licensing Program Analyst (LPA) Araceli Canela arrived announced to conduct a Case Management Inspection and to go over a recent Fire clearance that was requested for a bedroom to be used for bedridden. LPA met with licensee, Cecilia Ganzon and toured the home.


On January 5, 2024 this facility submitted a request for 1 bedridden and 16 non-ambulatory residents and a new fire clearance was approved by the Vallejo Fire department on 2/5/2024. The fire clearance is for room #9 to be used for one (1) bedridden resident.
The home was observed clean and at a comfortable temperature with all exits free from obstruction.
The facility will be issued an updated license for total capacity of 17 of which one may be bedridden and 16 non-ambulatory.


No citations were issued.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Araceli CanelaTELEPHONE: (707) 588-5041
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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