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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496830784
Report Date: 08/24/2023
Date Signed: 08/25/2023 09:49:53 AM

Document Has Been Signed on 08/25/2023 09:49 AM - 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:AMANI DAY SERVICESFACILITY NUMBER:
496830784
ADMINISTRATOR:CATIIS, REGINALD ROSSFACILITY TYPE:
775
ADDRESS:5420 STATE FARM DR SUITE ATELEPHONE:
(707) 791-3290
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 30CENSUS: 26DATE:
08/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Reginald Catiis-AdministratorTIME COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Alviso conducted a Required-1 Year visit, on 8/24/23 at approximately 9:00aM, and met with Administrator Reginald Catiis, and Supervisor Erica De Vera.

The LPA reviewed facility records.

The staff on-site all have criminal record clearance as required. LPA observed clients in care involved in activities during the inspection.

All exits were unobstructed. Fire extinguishers, two(2), were serviced and tagged, expired 1/27/24. The facility was clean and orderly during the inspection.

The annual will be continued by the Department at a later date.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2023
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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