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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804080
Report Date: 11/22/2022
Date Signed: 11/22/2022 01:56:45 PM

Document Has Been Signed on 11/22/2022 01:56 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:DANLE'S CARE HOME IIIFACILITY NUMBER:
486804080
ADMINISTRATOR:DANLE, SINNINFACILITY TYPE:
735
ADDRESS:811 WHITE WING LANETELEPHONE:
(707) 759-2028
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY: 4CENSUS: 4DATE:
11/22/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Sinnin DanleTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Walters arrived for the purpose of conducting a Post-Licensing inspection and met with Licnesee/Administrator, Sinnin Danle (6010244735 exp 2/24/24). When LPA arrived all of the clients were in day program.

During today’s visit LPA observed the following items:
· COVID-19 screening station with visitor log, thermometer, hand sanitizer
· Lockable separate cabinets for medications, toxins/cleaners, and knives.
· All exits were unobstructed
· Smoke detectors and carbon monoxide detectors, which were tested & observed operational
· Hand washing and supply of paper products available
· Non-slip mat in shower.
· Fire Extinguisher charged 10/25/22
· Required postings (Personal Rights, Emergency plan/numbers, CCLD "Let Us Know" complaint poster, Emergency Disaster Plan, Rights of Individuals with disabilities and COVID-19 signs
· Bedrooms were furnished as required per regulation
· LPA observed a one week supply of nonperishable foods one week and at least a two day supply of fresh perishable foods.

No deficiencies cited during today's inspection
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Katrina Walters
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2022
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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