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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002806
Report Date: 09/22/2021
Date Signed: 09/22/2021 01:08:11 PM

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:SPRINGVIEW ELDERLY CAREHOMEFACILITY NUMBER:
315002806
ADMINISTRATOR:ARCEGA, LOVELIEFACILITY TYPE:
740
ADDRESS:5536 GRAHAM CT.TELEPHONE:
(916) 672-6945
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:6CENSUS: 4DATE:
09/22/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Miles ParkinsonTIME COMPLETED:
01:15 PM
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Initial pre-licensing inspection shows that:

1) Hot water was measured at 95'

2) Backyard is cluttered. Discarded washer, discarded furniture, discarded headboard, discarded dining room table, various chairs, potty chairs (5), roofing tiles, tar paper bundle.

3) Backyard storage unit cannot be solidly secured / locked and contains chemicals.

4) Deadbolt on bathroom door.

5) Kitchen sink cabinet cannot be locked which contains bleach, Ajax, all purpose cleaning spray and various other cleaning chemicals.

All above items need to be addressed / removed / corrected prior to passing pre-licensing inspection.

Facility shall contact LPA upon completion of the above for reinspection.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Michael SmithTELEPHONE: (916) 208-7807
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
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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