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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045001608
Report Date: 01/05/2024
Date Signed: 01/05/2024 04:26:09 PM


Document Has Been Signed on 01/05/2024 04:26 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:COUNTRY HEARTSFACILITY NUMBER:
045001608
ADMINISTRATOR:LEONARD, CAROLFACILITY TYPE:
740
ADDRESS:7170 LOWER WYANDOTTE RD.TELEPHONE:
(530) 589-2466
CITY:OROVILLESTATE: CAZIP CODE:
95966
CAPACITY:15CENSUS: 0DATE:
01/05/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Natasha Leonard - administratorTIME COMPLETED:
05:00 PM
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01/05/202410: 4:30 PM Licensing Program Analyst (LPA) Rebecca Knight conducted an announced visit to the facility and met with administrator Natasha Leonard.

The purpose of this visit was to determine whether or not there were any residents in care. The facility closed on January 5, 2024 and the residents have all been relocated.

Ms. Leonard invited LPA Knight into the facility and allowed LPA to tour the facility. LPA observed the facility to be empty with no residents in care.

Administrator agreed to shred the license.

No deficiencies were cited during this visit. The report was provided to the administrator Natasha Leonard.

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:
DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/05/2024
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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