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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804202
Report Date: 02/20/2024
Date Signed: 02/20/2024 02:14:37 PM

Document Has Been Signed on 02/20/2024 02:14 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:ULINZI HOMEFACILITY NUMBER:
496804202
ADMINISTRATOR:KIHARA, EDDAHFACILITY TYPE:
735
ADDRESS:937 EMILY AVE.TELEPHONE:
(707) 293-8557
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 4CENSUS: 0DATE:
02/20/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Eddah Kihara-ApplicantTIME COMPLETED:
02:20 PM
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Licensing Program Analyst(LPA) arrived to conduct a subsequent pre-licensing Inspection and was greeted by Applicant, Eddah Kihara. Eddah Kihara will be the facility's Administrator, and has a current ARF certificate.

Component III orientation was completed on 1/23/24, with applicant, Eddah Kihara.

Facility has received a fire clearance approval from the local fire department- effective 10/3/23, for four (4) ambulatory clients. Fire extinguishers, three (3) were serviced, and tagged, as required. Facility has smoke alarms and a carbon monoxide detector as required; Each client room had a working carbon monoxide detector. Facility has a required infection control plan. Facility has required emergency disaster plan.

All items needing to be done in the home, listed in report dated 1/23/24, were observed to be completed as required.

Pre-Licensing is complete and this facility has no apparent health hazards and/or concerns observed during this inspection. The LPA will send a copy of the report to the Application Unit Analyst; The Application Unit Analyst will notify the applicant of the status of the application.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2024
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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