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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 576803973
Report Date: 03/03/2022
Date Signed: 03/03/2022 12:48:32 PM

Document Has Been Signed on 03/03/2022 12:48 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:GALILEO PLACE ADULT DAY PROGRAMFACILITY NUMBER:
576803973
ADMINISTRATOR:YOO, TANYAFACILITY TYPE:
775
ADDRESS:1909 GALILEO CT., STE. C.TELEPHONE:
(530) 758-5566
CITY:DAVISSTATE: CAZIP CODE:
95618
CAPACITY: 70CENSUS: DATE:
03/03/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Amy Meier, AdministratorTIME COMPLETED:
12:45 PM
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Licensing Program Analyst Jill Nakagawa made an unannounced visit to check on Guardian enrollment for upcoming opening.

Enrollment on 6 employees have gone through. Awaiting several more, but Guardian is now up and running after 5 weeks of problems.

LPA left a current list from the Guardian website of individuals cleared (Roster).
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2022
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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