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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 032701016
Report Date: 08/29/2023
Date Signed: 08/29/2023 10:21:53 AM

Document Has Been Signed on 08/29/2023 10:21 AM - 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:
08/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:48 AM
MET WITH:Aaron CocjinTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to the facility to conduct an annual required visit. LPA observed no cars in the driveway. LPA called Administrator Aaron Cocjin to inform of LPA's arrival. LPA was later met by Administrator Aaron.

According to Administrator Aaron, the licensees want to continue to keep the license active in addition to their vendorization with Valley Mountain Regional Center (VMRC). The facility currently has zero (0) residents in care.

LPA observed the physical plant to ensure compliance with Title 22 regulations. LPA observed the facility to be clean and free from debris. No emergency exits are obstructed. Fire extinguisher, carbon monoxide detector, and central heating and air system were observed to be in working condition.

Per California Code of Regulation (CCR) - Title 2, no deficiencies were observed during the visit. An exit interview was held, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2023
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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