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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804009
Report Date: 12/22/2021
Date Signed: 12/22/2021 03:32:18 PM

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:CLOVERDALE BETTER LIVING SENIOR CAREFACILITY NUMBER:
496804009
ADMINISTRATOR:GENET, MELISSAFACILITY TYPE:
740
ADDRESS:611 CHERRY CREEK ROADTELEPHONE:
(707) 367-2725
CITY:CLOVERDALESTATE: CAZIP CODE:
95425
CAPACITY:10CENSUS: 3DATE:
12/22/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:48 PM
MET WITH:Melissa GenetTIME COMPLETED:
03:42 PM
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Licensing Program Analysts Victoria Willis and Caitlynn Felias arrived unannounced to conduct a Pre-licensing inspection and met with Applicant, Melissa Genet.

LPAs conducted a walk through of the facility with Applicant to discuss their plans for the facility once the current Licensee has vacated. Facility currently has three residents and each of their rooms are furnished per regulation. Vacant rooms are not fully furnished but according to Applicant, they have furniture in storage and will furnish rooms once they take over the facility. Additional physical plant issues are currently being discussed/addressed including painting, heating and air conditioning and replacement of a window in a vacant resident room. Facility is currently having heating issues on one wing of the facility that is currently not occupied by residents. Areas occupied and used by residents were a comfortable temperature. Applicant is currently discussing next steps with the landlord. Additionally, a sink in a vacant resident room is loose at the wall. LPA and Applicant discussed options including removing the sink.

Personal items belonging to the current Licensee and live-in staff will be removed once Applicant takes over facility.

Applicant's Administrator Certificate has been renewed until 12/1/2023. Per conversation with Applicant, the fire clearance approval should be sent to CCL within the next day.

No deficiencies cited during this inspection.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria WillisTELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
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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