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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804238
Report Date: 07/24/2024
Date Signed: 08/01/2024 11:49:48 AM

Document Has Been Signed on 08/01/2024 11:49 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
CENTRALIZED APP UNIT, 744 P STREET, MS 9-14-8201
SACRAMENTO, CA 95814
FACILITY NAME:CARE HOME AT LARAMIE, THEFACILITY NUMBER:
486804238
ADMINISTRATOR/
DIRECTOR:		ADRIANO, RONMARKFACILITY TYPE:
740
ADDRESS:512 LARAMIE WAYTELEPHONE:
(707) 592-3539
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 6CENSUS: 4DATE:
07/24/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Robert Coleman (Licensee) &
Ronmark Adriano (Administrator)		TIME VISIT/
INSPECTION COMPLETED:
01:28 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
COMP II by CAB successfully completed
Facility Type: RCFE
Application Type: CHOW
Capacity: 6
Census : 4
Method: Telephone call with CAB

COMP II Participants: Robert Coleman (Licensee), Ronmark Adriano (Administrator), & Tammy Edwards, (Analyst).
Licensee & administrator participated in COMP II via Telephone call with CAB Analyst. Identification
of licensee/administrator was verified by confirming driver’s license numbers. During COMP II,
licensee/administrator confirmed the understanding of Title 22. Component II was successfully
completed. Licensee/administrator were advised to email signed LIC 809 with copy of photo ID to
CAB.

During COMP II, CAB analyst confirmed licensee's/administrator’s understanding of following
areas:
1. Facility operation: License type, client/resident populations, and program
2. Admission Policies
3. Staffing requirements & Training
4. Restrictive/Prohibited Health Conditions
5. General provisions
6. Emergency Preparedness
7. Complaints & Reporting
8. Pre-licensing readiness
SUPERVISORS NAME: Darla Neeley
LICENSING EVALUATOR NAME: Tammy Edwards
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024
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