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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496800196
Report Date: 08/31/2023
Date Signed: 08/31/2023 12:07:07 PM

Document Has Been Signed on 08/31/2023 12:07 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:DORIS'S HOUSEFACILITY NUMBER:
496800196
ADMINISTRATOR:CAMILLERI,DORIS&JOEFACILITY TYPE:
735
ADDRESS:432 CRIVELLI DR.TELEPHONE:
(707) 996-0581
CITY:SONOMASTATE: CAZIP CODE:
95476
CAPACITY: 4CENSUS: 4DATE:
08/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Joe & Doris Camilleri (Licensee)TIME COMPLETED:
12:20 PM
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Licensing Program Analysts (LPAs) Cuadra and Coppo arrived unannounced to conduct an Annual Required inspection and met with Licensees Joe and Doris Camilleri. Clients were attending to Day Program. Required postings were observed.

LPAs/Licensee initiated a tour of the facility and made the following observations: Facility was a comfortable temperature and pathways were free from obstructions. Client rooms are furnished per regulation. Water temperatures in client bathrooms read at 116.2 and 114.1 which is within regulation of 105 and 120 degrees F. At least two days of perishable and one week of non-perishable foods were available. Toxins are locked in a cabinet. Medications are centrally stored in locked cabinet located in the living room and medication records were reviewed. Fire extinguishers were last inspected April 2023. Smoke detectors and carbon monoxide detector are wired located throughout the facility were tested and operational. Most recent Fire/Disaster drill was conducted May 2023. Facility does have a current activity calendar and menu. Cash resources and documentation were reviewed.

At 10:00am LPA conducted a file review of four client and three staff files. Clients records have updated care plans on file. CPR/1st aid certificates and training hours are current. Administrator Certificate for Joe Camirelli 6038306740 expires 1/5/25.

Licensee submitted updates of the following documents: LIC500 (Personnel Report), LIC308 (Designation of facility responsibility), Surety bond, and LIC400 (cash affidavit for clients).
No deficiencies cited during today's inspection. Exit interview conducted with Administrator and a copy of this report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2023
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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