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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803505
Report Date: 10/01/2024
Date Signed: 10/01/2024 09:23:09 AM

Document Has Been Signed on 10/01/2024 09:23 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:TAKING THE JOURNEY LLCFACILITY NUMBER:
496803505
ADMINISTRATOR/
DIRECTOR:		DOSS, KISAFACILITY TYPE:
740
ADDRESS:512 CASA VERDE CIRCLETELEPHONE:
(707) 981-8751
CITY:PETALUMASTATE: CAZIP CODE:
94954
CAPACITY: 6CENSUS: 5DATE:
10/01/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:42 AM
MET WITH:Kelly Eriksen (Licensee)TIME VISIT/
INSPECTION COMPLETED:
09:38 AM
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Licensing Program Analyst (LPA) Cuadra conducted an unannounced case management inspection of facility and met with Kelly Eiksen, Licensee. The purpose of this case management is to follow up on updated fire clearance. There are five residents currently.

Licensee added a room to facility, submitted permits and fire clearance on 9/13/2024. LPA observed the new resident room, which appears to be in compliance with regulations.

No deficiencies cited during today's inspection. Exit interview conducted with Licensee and a copy of this report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2024
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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