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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803970
Report Date: 09/26/2024
Date Signed: 09/26/2024 10:10:30 AM

Document Has Been Signed on 09/26/2024 10:10 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:JESSIE'S PLACE, LLCFACILITY NUMBER:
486803970
ADMINISTRATOR/
DIRECTOR:		MURPHY, TINIKAFACILITY TYPE:
735
ADDRESS:122 CALIFORNIA ST.TELEPHONE:
(707) 731-1715
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY: 2CENSUS: 0DATE:
09/26/2024
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:22 AM
MET WITH:Tinika Murphy (Licensee)TIME VISIT/
INSPECTION COMPLETED:
10:25 AM
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Licensing Program Analyst (LPA) Cuadra conducted an announced Annual Required – 1 yr. required visit for this facility and was greeted by Licensee, Tinika Murphy. The facility currently has 0 clients in care. Annual fees are current. Contact information was reviewed,

LPA/Licensee toured the facility it was found to be clean and at a comfortable temperature with all exits free from obstruction. Client’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last serviced on July 2024. Smoke detectors and carbon monoxide detectors were tested found to be functioning. Toxins and cleaning supplies are stored in locked cabinets in the facility kitchen and storage room. There was a supply of cleaners, hygiene products and paper products available for clients. All client’s bedrooms have lighting & appropriate furnishings. Medications and records will be located in secured cabinets located in facility office. Water at faucets accessible to clients measured 105.6 degrees F which is within Title 22 Regulation between 105 and 120 degrees F. Administrator Certificate for Tinika N Murphy, #6056489735, expires on 11/02/2024.

Licensee provided copies of the following documents: LIC 308 Designated Facility Responsibility, LIC 610 Emergency Disaster Plan, Copy of Administrator Certificate and Copy of Liability Insurance.

No deficiencies cited during today's visit. Exit interview was conducted with Licensee and a copy of this report was provided.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
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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