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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 236803766
Report Date: 08/30/2022
Date Signed: 08/30/2022 10:26:42 AM

Document Has Been Signed on 08/30/2022 10:26 AM - 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:AZALEA HOUSEFACILITY NUMBER:
236803766
ADMINISTRATOR:AYALA, ALMIDAFACILITY TYPE:
740
ADDRESS:209 AZALEA CIRTELEPHONE:
(707) 964-4940
CITY:FORT BRAGGSTATE: CAZIP CODE:
95437
CAPACITY: 4CENSUS: 4DATE:
08/30/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Almida AyalaTIME COMPLETED:
10:30 AM
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At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility announced, to meet with Administrator Almida Ayala to assist in a review of their infection control plan and physical inspection of the facility. LPA reviewed plan and found it meets expectations. LPA toured the home and found it to be clean and well organized. Facility staff are trained on the infection control plan and retrained as updates are generated. LPA was able to answer questions staff presented to better understand regulation.

No citations issued during this visit.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2022
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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