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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
486804191
Report Date:
08/13/2024
Date Signed:
08/13/2024 11:58:27 AM
Document Has Been Signed on
08/13/2024 11:58 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:
FARMSTEAD AT DIXON, THE
FACILITY NUMBER:
486804191
ADMINISTRATOR/
DIRECTOR:
MARK REYES
FACILITY TYPE:
740
ADDRESS:
350 GATEWAY DRIVE
TELEPHONE:
(707) 592-1157
CITY:
DIXON
STATE:
CA
ZIP CODE:
95620
CAPACITY:
96
CENSUS:
33
DATE:
08/13/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:
Mark Reyes, Administrator
TIME VISIT/
INSPECTION COMPLETED:
12:05 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct a case management visit to follow up on resident R1 and their medication management.
LPA met with Administrator Mark Reyes and Care Coordinator Jolene Barnett.
The Administrator and Care Coordinator are working closely with R1's family and doctors to ensure that R1's personal rights are respected and that R1's health condition is monitored. LPA observed R1 and found the facility's staff to be diligent in working with R1 to continually maintain a good rapport and high level of trust.
There were no deficiencies found at the time of visit and no citations issued.
SUPERVISORS NAME
:
Kimberley Mota
LICENSING EVALUATOR NAME
:
Jill Nakagawa
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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