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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570317743
Report Date: 02/07/2023
Date Signed: 02/07/2023 03:18:29 PM

Document Has Been Signed on 02/07/2023 03:18 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:DAVIS SUMMER HOUSEFACILITY NUMBER:
570317743
ADMINISTRATOR:JULIE HUNTERFACILITY TYPE:
735
ADDRESS:2525 EAST 8TH STREETTELEPHONE:
(530) 757-1294
CITY:DAVISSTATE: CAZIP CODE:
95618
CAPACITY: 14CENSUS: 11DATE:
02/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH: Management Support Staff (S3)TIME COMPLETED:
03:30 PM
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LIcensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct a case management visit.

The facility was found to be clean, orderly, and well-maintained. The facility came through the recent storms unscathed, with the yard and fences looking good. Residents were excited to receive new patio furniture.

LPA spoke with Executive Director, Julie Kirby (JK), via phone regarding the Administrator for Davis Summer House. The facility will maintain the current Administrator (S2) until staff member (S1) completes the Administrator's Course (the final class day is 2/7/23) and passes the Administrator's exam. At that point the Executive Director will place S1 in place as the Administrator.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2023
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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