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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002891
Report Date: 06/10/2024
Date Signed: 06/10/2024 02:38:44 PM


Document Has Been Signed on 06/10/2024 02:38 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:FOOTHILL COTTAGEFACILITY NUMBER:
045002891
ADMINISTRATOR:ABEJO, KRISTINEFACILITY TYPE:
740
ADDRESS:3064 CEANOTHUS AVENUETELEPHONE:
(530) 809-0418
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY:6CENSUS: DATE:
06/10/2024
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Administrator Kristine Abejo TIME COMPLETED:
02:24 PM
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On 6/10/2024 LPA Jaynae Boyles and LPM Lauren Crocker held an office meeting with Licensee/Administrator Kristine Abejo to review the outcome of her 2nd level appeal regarding a complaint that was received by the Department on 9/20/22 along with reviewing the 1st level appeal for a citation from the facilitys annual inspection on July 24, 2023 and issue her Cleared Plan of Correction letter.
During a complaint investigation in September of 2022 it was established that a Technical Violation occurred and is attached to this office visit.
The TV (advisory note)
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae BoylesTELEPHONE: (916) 208-6251
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2024
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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