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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804034
Report Date: 02/09/2023
Date Signed: 02/09/2023 10:22:04 AM

Document Has Been Signed on 02/09/2023 10:22 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:TUSCAN MANOR E LLCFACILITY NUMBER:
496804034
ADMINISTRATOR:ARIZMEDI, EUFRASIAFACILITY TYPE:
740
ADDRESS:1920 GROSSE AVENUETELEPHONE:
(707) 328-2546
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY: 6CENSUS: 6DATE:
02/09/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Licensee, Eufrasia (Oliva) Garcia ArizmendiTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Bertozzi arrived unannounced and met with Licensee, Eufrasia (Oliva) Garcia Arizmendi.

LPA is conducting this visit to amend the LIC809 for the Annual Inspection that occurred 1/26/2023.

No deficiencies cited.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2023
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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