Facility Evaluation Report

An office meeting was conducted today in the Santa Rosa Regional Office with Licensing Program Manager (LPM), Victoria Bertozzi, Licensing Program Analyst (LPA), Caitlynn Felias, Prospective Licensee, Tasha Harris, and Prospective Administrator, Lance Parker regarding the Emergency Approval to Operate (EAO) for Douglas Home #496804127. Licensee has passed away and Prospective Licensee, Tasha Harris will 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. Tasha Harris will have 60 days to send the remaining documents for the application aside from the control of property, which is needed as soon as possible. A copy of the documents submitted was provided to Tasha Harris.

No deficiencies cited during today's office meeting.

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