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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570303745
Report Date: 07/21/2023
Date Signed: 07/21/2023 01:55:12 PM

Document Has Been Signed on 07/21/2023 01:55 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:ASHLEY MURILLOFACILITY TYPE:
772
ADDRESS:24321 COUNTY ROAD 96TELEPHONE:
(530) 753-1653
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY: 10CENSUS: 8DATE:
07/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Ashley Murillo, AdministratorTIME COMPLETED:
01:55 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an Annual Inspection. Administrator Ashley Murillo showed LPA Nakagawa through the facility. Facility was found to be clean, orderly, and at a comfortable temperature with all exits free from obstruction. Toxins are stored in locked cabinets. There was a sufficient supply of hygiene products, cleaners, and paper products for use as needed. Medications were stored and locked in a small med room making them inaccessible to residents and staff that do not handle medications. All bathrooms had soap and paper towels. Facility has a sufficient supply of personal protective equipment (PPE). Infection Control Plan was received by the Department on 06/30/2022. There was an ample supply of perishable and non-perishable foods as per regulation . The facility had 4 fire extinguishers that were last tested on Oct 10, 2022 and they were fully charged. The facility had 3 carbon monoxide detectors that were operational. The facility also has a barn that houses chickens and goats which are cared for by the residents. There is also a large garden with vegetables and flowers growing all over the property which the residents also help care for.

There were 3 staff members on site, and eight (8) residents in care at the facility during this inspection.

No deficiencies during today's inspection.
No citations issued.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2023
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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