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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 041373048
Report Date: 05/31/2022
Date Signed: 05/31/2022 04:14:39 PM


Document Has Been Signed on 05/31/2022 04:14 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:GISELLE'S CARE HOME #2FACILITY NUMBER:
041373048
ADMINISTRATOR:MEMORACION, ELIZABETHFACILITY TYPE:
740
ADDRESS:2140 CERES AVENUETELEPHONE:
(530) 893-8078
CITY:CHICOSTATE: CAZIP CODE:
95926
CAPACITY:6CENSUS: 0DATE:
05/31/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Elizabeth MemoracionTIME COMPLETED:
04:25 PM
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On 5/31/22, Licensing Program Analyst (LPA) Jaclyn Avila met with Licensee Elizabeth Memoracion regarding the closure of her facilities. LPA toured the facility and confirmed there are no longer clients in care. The last resident moved out as of March 5th, 2022 which is when the licensee closed her business. The facility is being closed due to the licensee retiring from the field.

No deficiencies found during todays visit.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Jaclyn AvilaTELEPHONE: (530) 895-4275
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2022
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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