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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570303745
Report Date: 08/12/2022
Date Signed: 08/12/2022 02:21:25 PM

Document Has Been Signed on 08/12/2022 02:21 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:FARMHOUSE, THEFACILITY NUMBER:
570303745
ADMINISTRATOR:ELIZABETH HALLFACILITY TYPE:
772
ADDRESS:24321 COUNTY ROAD 96TELEPHONE:
(530) 753-1653
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY: 10CENSUS: 10DATE:
08/12/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Travis Jones, Lead Staff, Behavioral Health TIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced on 08/12/2022 at approximately 1:15 PM for the purpose of checking on the Eviction process of a resident initiated on 8/01/2022. During the visit LPA conducted an inspection and found the facility to be clean and orderly. The grounds were full of flowers and vegetables growing.

LPA reviewed documentation for the Eviction. The Notice meets the standard as indicated in the regulation:
Title 22, Division 6, Chapter 2, Article 6, 81068.5 Eviction Procedures. The resident has met with their support team and are currently looking for a facility that will meet the needs of the resident/client going forward.

The staff and resident are waiting for an opening in another program in Yolo County.

There were no deficiencies noted at the time of the visit.

No citations issued.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 08/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/12/2022
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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