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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216801830
Report Date: 06/16/2021
Date Signed: 06/16/2021 11:49:38 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:L'CHAIM HOUSEFACILITY NUMBER:
216801830
ADMINISTRATOR:CARY KOPSTEINFACILITY TYPE:
740
ADDRESS:777 MONTECILLO ROADTELEPHONE:
(415) 435-1395
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY:6CENSUS: 0DATE:
06/16/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Administrator, Cary KopsteinTIME COMPLETED:
12:00 PM
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Licensing Program Analysts (LPAs) Farhaan Sarangi and Erik Gonzalez-Campos arrived at L’Chaim House announced for a voluntary facility Closure, and met with the Administrator, Cary Kopstein. Community Care Licensing (CCL) received a letter via email requesting a closure of the facility and stated that there were no residents in care.

The Licensee notified Community Care Licensing of intent to close this facility on April 15, 2021 via email. Closure plans and copies of letters given to clients were reviewed. Licensee notified CCL that the facility will be closing on June 15, 2021.

The licensee initiated this facility closure. LPA Sarangi and Gonzalez-Campos inspected all rooms and the exterior of the building and found no evidence that would suggest that clients are residing on the premises. All furniture, clothing and personal items belonging to clients have been removed. Clients that were living in the home were relocated to other properties in Sonoma and Marin Counties.

Administrator will mail out license to the Regional Office. Facility will be closed effective June 16, 2021. Exit interview was conducted and a copy of this report was emailed to the Administrator, Cary Kopstein.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5029
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: 707-588-5034
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021
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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