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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577000881
Report Date: 11/15/2024
Date Signed: 11/15/2024 03:25:48 PM

Document Has Been Signed on 11/15/2024 03:25 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:ATRIA COVELL GARDENSFACILITY NUMBER:
577000881
ADMINISTRATOR/
DIRECTOR:		BARBARA FLECKFACILITY TYPE:
740
ADDRESS:1111 ALVARADO AVETELEPHONE:
(530) 756-0700
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY: 210TOTAL ENROLLED CHILDREN: 0CENSUS: 159DATE:
11/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:54 PM
MET WITH:Barbara Fleck, via phoneTIME VISIT/
INSPECTION COMPLETED:
03:25 PM
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LIcensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct a Case Management visit regarding multiple incidents around R1. LPA met with Administrator via phone.

The Administrator and staff are monitoring R1 for any changes in condition and seeking supports for his care.

LPA conducted interview and collected documents.

There were no deficiencies and no citations issued at the time of visit.

Manager on Duty, Andrew Conley reviewed and signed the report, for Administrator Barbara Fleck who was not on site at the time of visit.
Kimberley MotaTELEPHONE: (707) 588-5051
Jill NakagawaTELEPHONE: 707-588-5063
DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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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