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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 097005326
Report Date: 02/10/2022
Date Signed: 02/10/2022 01:32:16 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/10/2022 01:32 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:
02/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jillian SmithTIME COMPLETED:
01:30 PM
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LPA Smith communicated with administrator Jillien Smith. Facility has not been operational for approximately 2 years due to the pandemic and recently suffered a water leak. Due to the water leak, the facility is requiring mold remediation and waiting on reconstruction with replacing insulation, sheet rock and a significant section of flooring .

It is unknown when the facility is scheduled to reopen due to the construction.

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: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2022
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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