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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803953
Report Date: 02/01/2024
Date Signed: 02/01/2024 01:24:51 PM

Document Has Been Signed on 02/01/2024 01:24 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:HIGH POINTE RESIDENCESFACILITY NUMBER:
486803953
ADMINISTRATOR:WARD, DANTEFACILITY TYPE:
735
ADDRESS:1737 YORK ST.TELEPHONE:
(707) 712-8038
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 4CENSUS: 4DATE:
02/01/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Dante Ward, AdministratorTIME COMPLETED:
01:30 PM
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On 2/1/2024, Licensing Program Analysts, Tobola, Coppo and Licensing Program Manager, Mota met with Administrator, Dante Ward for the purpose of an informal office meeting to discuss previous deficiencies and compliance concerns.

The party discussed the corrections implemented regarding former staff providing marijuana products to client (C1). Administrator stated that the former staff is no longer associated and informed that they can no longer be on the premise or providing care to clients moving forward.

In addition, the current pending plan of corrections were discussed regarding completed physician's reports and tuberculosis tests for clients C1 & C2. Administrator has submitted both client physician's reports and agrees to provide current tuberculosis test results for both clients.

No deficiencies cited.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2024
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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