<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803974
Report Date: 07/13/2023
Date Signed: 07/14/2023 11:18:49 AM

Document Has Been Signed on 07/14/2023 11:18 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: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: 6DATE:
07/13/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator Samuel PadamaTIME COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
The California Department of Social Services (CDSS) Community Care Licensing (CCL) Santa Rosa Regional Office conducted an informal meeting today 07/13/2023 by virtual calling with L & S Gentle Care II, 486803974. Present in the meeting were: Licensing Program Manager Kimberley Mota, Licensing Program Manager, Bethany Moellers, Licensing Program Analyst Karina Canela , Licensee and Administrator Samuel Padama, Licensee Imelda Padama, House Manager Enrique Marpa, and Assistant to the House Manager Imelda Garcia.

The purpose of this office meeting was to discuss areas of concern in the facility operation and putting L & S Gentle Care II facility on a Non-Compliance Conference (NCC) plan. Parties present during the meeting agreed to a NCC plan to bring the facility, L & S Gentle Care II, into compliance.


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

Compliance with California Title 22 Regulations and Community Care Licensing (CCL) Requirements
    • Recent substantiated Department of Labor (DOL) complaint
    • Fire Clearance and Safety Violations
    • Reporting Requirements
    • Facility Record Keeping
    • Staff Training Requirements
Additionally, Licensee understands staff shall not sleep or occupy any shed(s) on the premises, sleep in common areas of facility (living room couch, etc.) , and/or sleep/occupy constructed bedroom in the garage (unless approved by the Local Fire Department and a permit is obtained). Licensee understands pre-pouring medication is not allowed.

Technical Support Provider (TSP) assistance was offered to Licensees during this meeting.

*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: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1