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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803761
Report Date: 04/27/2023
Date Signed: 04/27/2023 05:58:54 PM

Document Has Been Signed on 04/27/2023 05:58 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:PRIMROSE SANTA ROSA DAY CLUBFACILITY NUMBER:
496803761
ADMINISTRATOR:WOTRING, JOHNFACILITY TYPE:
775
ADDRESS:2086 GUERNEVILLE RDTELEPHONE:
(707) 578-8360
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY: 25CENSUS: DATE:
04/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:John Wotring-LicenseeTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA), Alviso, is conducting a Required 1-Year visit, on 4/27/23 at approximately 11:20, and met with Licensee John Wotring. and Cynthia Tilker Program Director.

Facility has submitted the required Infection Control Plan, this is now part of the plan of operation. Fire extinguishers, two(2), were serviced and tagged as required- expires 6/8/23. Facility has them scheduled annually to be serviced and tagged before they expire. The day program has a fire clearance approval for 25 ambulatory clients. The day program operates Monday through Friday, 9am to 5pm. Currently there are nine(9) clients participating in day program services at this time. During the inspection, LPA observed the clients, who were in the common area, involved in an activity, saying hello and petting a small dog that came to visit. Facility was found to be clean and orderly during inspection.

The LPA will continue this Required 1-Year visit at a later date.


SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2023
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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