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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801409
Report Date: 07/02/2021
Date Signed: 07/02/2021 10:34:07 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:ANSON PLACE RESIDENTIAL CARE HOMEFACILITY NUMBER:
496801409
ADMINISTRATOR:DIMAPILIS, DANILOFACILITY TYPE:
740
ADDRESS:5926 ANSON DR.TELEPHONE:
(707) 538-4988
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY:6CENSUS: 0DATE:
07/02/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:54 AM
MET WITH:Danilo Dimapilis (Licensee)TIME COMPLETED:
10:50 AM
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Licensing Program Analyst (LPA) Cuadra arrived at the home for the purpose of conducting a closure inspection pursuant to voluntary closure of this licensed Residential Care Facility for the Elderly. LPA was greeted by the Licensee Danilo Dimapilis. LPA/Licensee toured the facility and licensee told LPA that they are in the process of retiring and will sell the house.

LPA inspected all rooms and the exterior of the building today and found no evidence that would suggest that any residents are residing on the premises. All clothing and personal items belonging to clients have also been removed.

The Licensee initiated this facility closure with plans for retirement and did not submitted a closure plan. On 4/5/2021 Licensee informed CCL verbally their intent to close the facility. Per Licensee, he notified Long Term Ombudsman and the last resident moved out on May, 2021.

Closure of this facility has been finalized. Facility was closed effective 7/2/21. Licensee turned over copy of License during today's inspection.

No deficiencies cited during today's visit.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021
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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