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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 032701016
Report Date: 03/29/2023
Date Signed: 03/29/2023 04:16:25 PM

Document Has Been Signed on 03/29/2023 04:16 PM - It Cannot Be Edited

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.270
SACRAMENTO, CA 95833
FACILITY NAME:POPPY LANE CARE HOMEFACILITY NUMBER:
032701016
ADMINISTRATOR:COCJIN, AARONFACILITY TYPE:
735
ADDRESS:100 POPPY LANETELEPHONE:
(559) 360-9058
CITY:IONESTATE: CAZIP CODE:
95640
CAPACITY: 4CENSUS: 0DATE:
03/29/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Aaron Cocjin, Rosemaire Ferrer, and Angelo FerrerTIME COMPLETED:
10:45 AM
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An office meeting was held today in the Sacramento South Regional Office via Microsoft Team to discuss the status of the home, corporation, and future plans. Present in the meeting was Valley Mountain Regional Representative (VMRC) Chris Pillsbury, Ferrer Home Care Inc. Representatives; Aaron Cocjin, Rosemarie Ferrer, and Angelo Ferrer, and Community Care Licensing Representatives; Regional Manager (RM) Stephenie Doub, Licensing Program Manager (LPM), and Licensing Program Analyst (LPA) Christina Valerio.

According to VMRC, CCL, and Facility representatives, there are currently no residents in the care. The facility does not have active staff members and cannot accept residents at this time. Licensee do not want to close the facility and would like to maintain current vendor number with VMRC and license with CDSS. Licensees plan to retire and discussed potential future plans of change of ownership with CCL and VMRC representatives. RM Doub stated that a change of ownership would need to occur if they make more than a 50% change to their corporation. A change of ownership would initiate a new license and vendorization.

It was determined that the licensees will work with VMRC and CCL on the change of ownership. Administrator Aaron will be the point of contact.

LPA to provide assistance regarding the change of ownership application, if needed.

VMRC C. Pillsbury to hand off the information to VMRC Manager R. Hernandez

Licensees to communicate with LPA and VMRC throughout the process.

An exit interview was held, and a copy of the report will be provided via e-mail. A signature will be requested on the hard copy. Licensee to send back to LPA with signature.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2023
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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