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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293622287
Report Date: 05/19/2021
Date Signed: 05/19/2021 02:09:51 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:CONECTA (PS)FACILITY NUMBER:
293622287
ADMINISTRATOR:LARA, ABBIEFACILITY TYPE:
850
ADDRESS:12716 NORTHWOODS BLVD, SUITE 5TELEPHONE:
(530) 386-8853
CITY:TRUCKEESTATE: CAZIP CODE:
96161
CAPACITY:30CENSUS: 8DATE:
05/19/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:36 AM
MET WITH:Abbie Lara - AdministratorTIME COMPLETED:
09:00 AM
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NOTE: Due to Covid-19 and DPH guidelines on physical distancing, a Tele-visit via Zoom was conducted.

On Wednesday, May 19th, 2021, at 8:36am, Licensing Program Analyst (LPA) Blake Morillas, at the request of the Administrator, Abbie Lara, conducted a Case Management Tele-visit for the purpose of introducing the facility's new Co-Director, Simone Tenorio, to the LPA.

Via Zoom, I introduced my self and the three of us had a brief conversation about our individual rolls.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.

This report (LIC 809), Appeal Rights (LIC 9058) and a Notice of Site Visit (LIC 9213) will be delivered to the Administrator electronically via email.

Acknowledgement of delivery will constitute acknowledgement of the report in lieu of a signature
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
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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