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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804021
Report Date: 01/14/2025
Date Signed: 01/14/2025 04:48:45 PM

Document Has Been Signed on 01/14/2025 04:48 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:WALK OF LIFE RESIDENTIAL CARE ARFFACILITY NUMBER:
486804021
ADMINISTRATOR/
DIRECTOR:		LANDAS, JENNIFERFACILITY TYPE:
735
ADDRESS:3124 MUSE WAYTELEPHONE:
(707) 439-1816
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 4CENSUS: 2DATE:
01/14/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:51 PM
MET WITH:Dawn Duey, DSP and Jennifer Landas, Administrator via phoneTIME VISIT/
INSPECTION COMPLETED:
04:50 PM
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On 01/14/2025, Licensing Program Analyst (LPA) Jill Nakagawa, arrived at the facility for the purpose of conducting a case management regarding a self-reported incident report involving C1 and S1. LPA met with DSP Dawn Duey and Administrator Jennifer Landas via phone and explained the purpose of the visit.

LPA conducted interviews, collected documents and requested police report. CCL will await medical examination results and conduct additional interviews. S1 is currently on administrative leave during the investigation.

No deficiencies found at the time of visit.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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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