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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803974
Report Date: 01/25/2023
Date Signed: 07/14/2023 02:03:48 PM

Document Has Been Signed on 07/14/2023 02:03 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:L & S GENTLE CARE IIFACILITY NUMBER:
486803974
ADMINISTRATOR:PADAMA, SAMUELFACILITY TYPE:
740
ADDRESS:778 APPALOOSA CTTELEPHONE:
(707) 846-1100
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 6CENSUS: DATE:
01/25/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Administrator Samuel PadamaTIME COMPLETED:
04:45 PM
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The Santa Rosa Regional Office conducted an informal meeting today 01/25/2023 by virtual calling with L & S Gentle Care II. Present in the meeting were: Licensing Program Manager Hope DeBenedetti, Licensing Program Analyst Karina Canela, LPA Katrina Walters, Licensee and Administrator Samuel Padama, and Licensee Imelda Padama. The purpose of the informal office meeting was to discuss areas of concerns with L & S Gentle care II facility.

Items addressed during the meeting include, but are not limited to, areas:

    • Previous compliance with California Title 22 Regulations and Community Care Licensing (CCL) Requirements
    • Labor concerns
    • Previous concerns during complaint investigation and case management visits, which were corrected

No citations issued at this time


*A copy of this report was emailed to Administrator; signature in file.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Karina Canela
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2023
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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