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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803627
Report Date: 01/26/2023
Date Signed: 01/26/2023 01:39:24 PM

Document Has Been Signed on 01/26/2023 01:39 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:NARASOL HOMEFACILITY NUMBER:
496803627
ADMINISTRATOR:NARCISO, JENNICA AFACILITY TYPE:
734
ADDRESS:2175 GROSSE AVETELEPHONE:
(510) 305-8919
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY: 5CENSUS: 4DATE:
01/26/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Facility Manager, Sely JuansonTIME COMPLETED:
01:50 PM
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Licensing Program Analyst Bertozzi arrived unannounced to conduct a Case Management inspection and met with Facility Manager, Sely Juanson. Administrator, Jennica Narciso arrived later.

LPA is following up regarding a leak that was recently reported by the Administrator. Per report dated January 6, 2023 , facility had a ceiling leak due to the recent rain. The leak was in an area that is not directly used by clients in care. Based on LPA observations during this visit as well as a conversation with facility staff, the leak has been remedied and the ceiling was repaired. Per conversation with Administrator, repairs were completed on January 13, 2023.

No deficiencies cited during this inspection.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2023
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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