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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286803024
Report Date: 12/15/2022
Date Signed: 12/15/2022 09:40:15 AM


Document Has Been Signed on 12/15/2022 09:40 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:CRINELLA HOME CAREFACILITY NUMBER:
286803024
ADMINISTRATOR:GUTIERREZ, JUANAFACILITY TYPE:
740
ADDRESS:1726 CRINELLA DRIVETELEPHONE:
(707) 963-5289
CITY:ST. HELENASTATE: CAZIP CODE:
94574
CAPACITY:5CENSUS: 0DATE:
12/15/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee/Administrator, Juana GutierrezTIME COMPLETED:
09:45 AM
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Licensing Program Analyst arrived unannounced on 12/15/2022 to conduct a closure inspection for Crinella Home Care. LPA met with Licensee, Juana Gutierrez.

At the time of the last required 1 year inspection there were 3 residents. Residents have since moved to licensee's other care home. LPA toured the facility and observed nothing that would indicate residents are still residing at the property. This a licensee initiated closure.

LPA obtained physical copy of the license during inspection. LPA will proceed with finalization of facility closure. Facility will be closed effective date 12/15/2022.

Exit interview conducted with licensee/administrator, Juana Gutierrez and a copy of this report sent to her email.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Erik Gonzalez CamposTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2022
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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