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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
315002937
Report Date:
02/08/2023
Date Signed:
02/08/2023 12:11:39 PM
Document Has Been Signed on
02/08/2023 12:11 PM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL
,
520 COHASSET RD., STE. 170
CHICO
,
CA
95926
FACILITY NAME:
SERENITY HOME FOR SENIOR
FACILITY NUMBER:
315002937
ADMINISTRATOR:
CADORNA, JULIUS
FACILITY TYPE:
740
ADDRESS:
5406 SAGE CT
TELEPHONE:
(916) 203-6993
CITY:
ROCKLIN
STATE:
CA
ZIP CODE:
95765
CAPACITY:
6
CENSUS:
4
DATE:
02/08/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
09:00 AM
MET WITH:
Rosemarie Cadorna, Adminsitrator
TIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to continue investigation into allegations listed above. LPA spoke with one of the managers Rosemarie Cadorna over the phone and met with former licensee Zoe Trinh. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask.
LPA arrived to review resident files concerning an incident that occurred on prior license. Documents reviewed and received.
No deficiencies cited today.
Exit interview conducted.
SUPERVISOR'S NAME:
Troy Ordonez
TELEPHONE:
(916) 263-4832
LICENSING EVALUATOR NAME:
Bethany Mirlohi
TELEPHONE:
(916) 591-1072
LICENSING EVALUATOR SIGNATURE:
DATE:
02/08/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/08/2023
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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