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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804080
Report Date: 10/12/2023
Date Signed: 10/12/2023 12:06:49 PM

Document Has Been Signed on 10/12/2023 12:06 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:
10/12/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:44 AM
MET WITH:Sinnin Danle, LicenseeTIME COMPLETED:
12:15 PM
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On 10/12/2023, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of conducting a Case Management Visit, requesting for signature on client (C1) consent for a release of client medical information. LPA was greeted by by License, Sinnin Danle and informed them of the signature request.

Licensee spoke with client C1 and explained the reason for the visit. C1 agreed to sign the request for release of client medical information and was provided to LPA.

LPA Tobola also spoke with the Licensee on current repairs to the kitchen and bathroom areas due to leaking observed in July 2023. Licensee contacted the contractor for expected completion dates on the repairs and is currently waiting on approval from the insurance. Licensee will be notifying LPA of any updates moving forward.

No deficiencies cited during today's visit.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023
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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