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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 097005326
Report Date: 12/14/2021
Date Signed: 12/14/2021 02:44:41 PM

Document Has Been Signed on 12/14/2021 02:44 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:SENIOR DAY CARE CENTER- EL DORADO HILLSFACILITY NUMBER:
097005326
ADMINISTRATOR:JILLIEN SMITHFACILITY TYPE:
775
ADDRESS:990 LASSEN LANETELEPHONE:
(916) 358-3560
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY: 30CENSUS: 0DATE:
12/14/2021
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Jillien Smith (Telephone)TIME COMPLETED:
12:15 PM
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LPA Smith spoke with administrator Jillien Smith. Facility has not been operational for approximately 2 years due to the pandemic.

Facility is tentatively scheduled to reopen 1/31/2022.

Administrator to contact Community Care Licensing, Michael Smith, at the below referenced number upon reopening.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Michael Smith
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2021
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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