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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
576803964
Report Date:
08/13/2024
Date Signed:
08/13/2024 04:29:17 PM
COMPREHENSIVE INSPECTION
Document Has Been Signed on
08/13/2024 04:29 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:
ARVEAH'S CARE HOMES 2
FACILITY NUMBER:
576803964
ADMINISTRATOR:
DAVIS, ARVIN
FACILITY TYPE:
740
ADDRESS:
605 CONNOR LANE
TELEPHONE:
(650) 219-3369
CITY:
WOODLAND
STATE:
CA
ZIP CODE:
95695
CAPACITY:
8
CENSUS:
8
DATE:
08/13/2024
TYPE OF VISIT:
Case Management - Annual Continuation
UNANNOUNCED
TIME BEGAN:
03:51 PM
MET WITH:
Leah Davis, Licensee via phone
Elena Torres, Caregiver
TIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an Annual - Continuation Inspection to review the resident and staff records. LPA was allowed entry by care staff .
LPA was unable to inspect files due to technical difficulties. LPA and Licensee discussed the importance of having staff and resident files available for review at all times. Licensee will recover all files for LPA's review by 08/16/2024.
A technical advisory was issued. No citations were issued at the time of inspection.
SUPERVISOR'S NAME:
Kimberley Mota
TELEPHONE:
(707) 588-5051
LICENSING EVALUATOR NAME:
Jill Nakagawa
TELEPHONE:
707-588-5063
LICENSING EVALUATOR SIGNATURE:
DATE:
08/13/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/13/2024
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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