Facility Evaluation Report

An office meeting was conducted today in the Santa Rosa Regional Office with Regional Manager, Carla Nuti-Martinez, Licensing Program Manager (LPM), Victoria Bertozzi and Prospective Licensee, Mario Gray regarding the Emergency Approval to Operate (EAO) for Harrison Home Care #480109899. Licensee/Administrator has passed away and Prospective Licensee, Mario Gray would like to continue the operation of this facility.

Prospective Licensee has provided the following documents with the intent to continue operation of the facility:

During today's meeting Community Care Licensing (CCL) received the application fee along with the above documents. Mario Gray will have 60 days to send the remaining documents for the application. A copy of the documents submitted was provided to Mario Gray. An Emergency Approval to Operate was provided.

No deficiencies cited during today's office meeting.

Exit interview conducted. Copy of report discussed and provided to Prospective Licensee. Signature on form confirms receipt of documents.