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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 576804189
Report Date: 02/07/2025
Date Signed: 02/07/2025 12:46:19 PM

Document Has Been Signed on 02/07/2025 12:46 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:ALAGA RANCHFACILITY NUMBER:
576804189
ADMINISTRATOR/
DIRECTOR:		ABDALLA,DOUGLASFACILITY TYPE:
740
ADDRESS:34606 CA-16TELEPHONE:
(530) 668-8444
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY: 23CENSUS: 14DATE:
02/07/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:Maggie Perri, Facility Director on site
and Douglas Abdalla, Licensee/Administrator via phone		TIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 02/07/2025 Licensing Program Analyst (LPA) Jill Nakagawa conducted a pre-licensing inspection and was greeted by Facility Director Maggie Perri. LIcensee/Administrator Douglas Abdalla was reached via phone. This pre-licensing inspection is being conducted for a change in ownership. Fire Clearance has been approved for 23 non-ambulatory, 10 of which may be bedridden.

LPA conducted a tour and inspection of the indoor portions of both buildings and outdoor portions of the facility. Facility was found to be clean and comfortable temperature with bedroom doors free from obstruction. Fire extinguishers throughout the facility were found to be last charged on 11/14/2024. Smoke detectors and carbon monoxide detectors were tested in common areas and client bedrooms all of which were found to be in working order. Water temperature was measured throughout the facility and found within regulation between 105 & 120 degrees F.

There was an ample supply of linens with appropriate bedding equipped in resident rooms. An additional supply of hygiene, continence and paper products are located in a secured storage closet. Hallways are illuminated around the clock for accessibility and resident bedrooms have appropriate furnishings. There is a sufficient amount of dishes and cooking supplies with sharps and other hazardous items kept secured in designated drawer. Cleaning products and other toxins and chemicals are kept out of client access and found secured in the office and laundry room cabinets. LPA observed adequate supply of both perishable and non-perishable food sufficient for the fourteen (14) residents in care. The facility will be conducting weekly grocery replenishment with consideration to resident preferences and dietary restrictions. A sample menu is posted in the kitchen located on the refrigerator and indicates a healthy and balance set of meals for residents in care.
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SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: ALAGA RANCH
FACILITY NUMBER: 576804189
VISIT DATE: 02/07/2025
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Medications are centrally stored and secured in locked medication carts in both buildings with Centrally Stored Medication Records and several other medication related forms on file. Client specified files including care plans, medical reports and dietary restrictions are located in an office located off the main building with all appropriate staffing records, program operation documentation and emergency disaster information. The facility has appropriate staffing in place.

The second building is called La Casita and has four residents. There is a kitchen, living room and dining room with a large deck for residents to enjoy. All required furnishings and additional amenities were in place.

The grounds of the facility features a large yard and deck with seating for client outdoor use, as well as pastures to watch horses and goats, chicken pen and walking paths with flowers and fruit trees. The facility has an Activity Calendar with activities planned throughout the day. Windows, screens and blinds are all found to be in good repair. The facility and facility operation plan are found to be adequate and tour of the facility completed.

Component III orientation was conducted with the Licensee/Administrator- Applicant via phone and the Facility Director on site. The pre-licensing evaluation has been completed. License will be granted upon completion of a final review and approval from the Licensing Program Manager. This report was reviewed with applicant and a copy was provided to the Licensee.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
LIC809 (FAS) - (06/04)
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