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Facility Evaluation Report

Shalamo Home, Novato04/30/2026Licence 216803917

Capacity4
Census3
Date signed04/30/2026 02:40:43 PM
Name of licensing program analystAnthony Loera
Name of licensing program managerKimberley Mota
The inspector’s account

04/30/2026; Licensing Program Analyst ( LPA) Loera arrived unannounced to conduct a case management visit and met with Lead Staff, Yadira Rodriguez. There are currently three clients in care, which all three were present during visit. Administrator, Jasmin Gongora was available via phone.

LPA observed areas of concern addressed in the Department of Developmental Services (DDS) onsite report dated 04/15/2026. Areas addressed were observed to be incompliance with Title 22 Regulations. The areas of concern noted by DDS are regarding regulations Buildings and Grounds (80087), Furniture and Fixtures (80088), and Health Related Services (80075).

LPA toured the facility and observed the kitchen faucet to be in working order, garage refrigerator's door to be in good repair, door handle leading to the backyard to be in good repair, emergency food supplies to be in a separate locked cabinet from cans of paint, and three out of three client MARs records for PRNs to be completely filled out. LPA observed the front garden area to have pvc piping that was not being used and not connected to any water source and does not affect the facility in anyway. Piping was observed to be pushed against the the facilities wall being obstruction free. LPA observed the front garden to be covered with bark with some exposed black tarp in certain areas, which is cosmetic. LPA observed a drawer underneath the oven to not shut fully but is still functional. LPA observed window screens missing in two out of two bathrooms, per conversation with lead staff they have a client (C1) who will push out window screens if they replace them and could trigger the clients behavioral as they are OCD and likes things to be a certain way. LPA observed one bathroom toilet to have a missing tank lid, per conversation with lead staff, a client (C2) had a behavior on 02/01/2026. Community Care Licensing (CCL) received a special incident report (SIR) on 02/03/2026 regarding C2 throwing the bathroom tank outside. The facility replaced the tank lid and then C1 broke the lid on 4/7/2026. Per conversation with lead staff they had a work order put in for a new toilet lid on 4/7/2026 which is still pending. LPA observed the bathroom toilet to still be functional.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction