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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 097003240
Report Date: 12/17/2021
Date Signed: 12/21/2021 09:01:32 AM

Document Has Been Signed on 12/21/2021 09:01 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:NEW WEST HAVEN II (ADC)FACILITY NUMBER:
097003240
ADMINISTRATOR:REBECCA LEIKAUFFACILITY TYPE:
775
ADDRESS:2551 CAMEO LANETELEPHONE:
(888) 852-5930
CITY:CAMERON PARKSTATE: CAZIP CODE:
95682
CAPACITY: 28CENSUS: 0DATE:
12/17/2021
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Tanya LanglandTIME COMPLETED:
10:45 AM
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LPA Smith spoke with day program representative, Sunny Matkovich via telephone call. Facility has not been operational for approximately 2 years due to the pandemic.

Facility is not scheduled to reopen in the immediate future.

Administrator / Licensee shall contact Community Care Licensing representative Michael Smith, at the below referenced number upon reopening.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Michael Smith
LICENSING EVALUATOR SIGNATURE: DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2021
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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