<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 097001145
Report Date: 08/05/2021
Date Signed: 08/05/2021 11:17:28 AM

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:APPLE COUNTRY CARE HOME # 2FACILITY NUMBER:
097001145
ADMINISTRATOR:LAURA FOSSFACILITY TYPE:
740
ADDRESS:6245 EL DORADO STREETTELEPHONE:
(530) 622-3033
CITY:EL DORADOSTATE: CAZIP CODE:
95623
CAPACITY:6CENSUS: 0DATE:
08/05/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Rick HeiderTIME COMPLETED:
11:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Case management visit, licensee initiated. Licensee has decided to relinquish the license and close the facility. Walk through inspection revealed that the facility is under construction and there are no residents. Facility will be closed effective today, 8/5/2021.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Michael SmithTELEPHONE: (916) 208-7807
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1