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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700251
Report Date: 05/06/2022
Date Signed: 05/06/2022 11:03:21 AM


Document Has Been Signed on 05/06/2022 11:03 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:BROOKFIELD HOME CAREFACILITY NUMBER:
312700251
ADMINISTRATOR:MCGILL, RAMONAFACILITY TYPE:
740
ADDRESS:5342 BROOKFIELD CIRCLETELEPHONE:
(916) 415-1012
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:6CENSUS: 4DATE:
05/06/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ramona McGillTIME COMPLETED:
11:00 AM
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An office meeting was held today, 05/06/2022, via face-time Microsoft Teams meeting due to COVID-19 and precautionary measures. The purpose of today's meeting was to address the facility's control of property. The owner of the property gave notice that they are going to sell the property and the lease is up on June 30, 2022.

The following Licensing staff were present:
Troy Ordonez, Licensing Program Manager; Laura Munoz Licensing Program Manager; and Kerry Hiratsuka, Licensing Program Analyst (LPA)

The following representatives were present:
Ramona McGill, Licensee

The following topics were covered during today's meeting:
-change-of-location process if Licensee moves facility to another location
-if the licensee is able to lease the property from new owner of property than a new lease agreement is required
-facility closure plan if no solution if found
-eviction notice requirements and to send a copy of Community Care Licensing Division (CCLD)
-notification to residents and their responsible parties about events

Licensee shall keep Community Care Licensing Division updated on the status.

An exit interview was conducted and a copy of this report will be provided to the facility via email. A copy must be signed and returned to CCLD.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:
DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
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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