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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 126803492
Report Date: 03/16/2022
Date Signed: 03/16/2022 12:22:31 PM


Document Has Been Signed on 03/16/2022 12:22 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:CLEO'S HOMEFACILITY NUMBER:
126803492
ADMINISTRATOR:HANRAHAN-GEE, LEAHFACILITY TYPE:
740
ADDRESS:129 HIGGINS STREETTELEPHONE:
(707) 382-2697
CITY:EUREKASTATE: CAZIP CODE:
95501
CAPACITY:15CENSUS: 0DATE:
03/16/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Leah GeeTIME COMPLETED:
12:30 PM
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At approximately 11:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a case management visit in regards to the closure of this facility. LPA met with Administrator Leah Gee and toured the facility. LPA toured all rooms and the exterior of the building and found no evidence that would suggest that any residents are residing on the premises. All clothing and personal items belonging to residents have also been removed.

The Licensee initiated this facility closure and had submitted a closure plan. The plan came with a copy of the letter given to residents and their responsible parties regarding the facility's plan to close.

The closure of this facility has been finalized. Facility is closed effective 3/16/2022. Licensee turned over the License during this visit.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher ArnholdTELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2022
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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