<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000567
Report Date: 06/20/2024
Date Signed: 06/20/2024 11:13:10 AM


Document Has Been Signed on 06/20/2024 11:13 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:ADAMS FAMILY HOMEFACILITY NUMBER:
306000567
ADMINISTRATOR:THOMAS ADAMSFACILITY TYPE:
740
ADDRESS:16171 CAIRO CIRCLETELEPHONE:
(714) 501-5398
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY:6CENSUS: 0DATE:
06/20/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Contractor, Nicolas DiozonTIME COMPLETED:
11:25 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Claudia Gutierrez made unannounced visit for the purpose of conducting a closure visit. On June 14,2024, LPA Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA met with Contractor Nicolas Diozon and toured the facility and observed there are extensive renovations taking place at the facility and no residents or staff were present. Contractor Diozon informed LPA that he believed a change of ownership had taken place. At 8:57 a.m. LPA placed a call to Administrator (AD) Thomas Adams and left a voicemail requesting a call back.

On June 14, 2024 at 10:49 a.m., AD contacted LPA by phone and stated they will no longer be operating the facility. Per AD, they have lost control of property and have ceased operations. LPA informed AD that a closure visit would be conducted to ensure no residents are in care and AD stated they understood.

During today's visit, LPA met with Contractor Diozon who confirmed the location is no longer a facility and they have been hired by the new property owners to do renovations. LPA did a walk through of the property and confirmed there were no residents in care.

LPA thanked Contractor Diozon for their time and concluded the visit.

Facility closure letter will be mailed to Licensee address on file.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia GutierrezTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1