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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317000442
Report Date: 09/16/2021
Date Signed: 09/17/2021 05:04:17 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:LAKE VIEW TERRACEFACILITY NUMBER:
317000442
ADMINISTRATOR:SMITH, CAROLYNFACILITY TYPE:
740
ADDRESS:2600 SULLIVAN DR.TELEPHONE:
(530) 889-1136
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY:6CENSUS: 0DATE:
09/16/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:TIME COMPLETED:
12:02 PM
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On 9/16/2021 LPA Tryon traveled to the facility to make sure that there are no residents/clients living there. LPA had been told that the home had been closed and that the house had been rented out to a private renter.

Upon arrival LPA noted no cars in the driveway. LPA rang the doorbell several times. There was a dog barking inside, but no one ever answered the door. It would appear that there was no one at home at the time.

It appears that home has been closed and rented to a private citizen and is now a private residence.

The license will be closed as of June 18, 2021, the date that LPA spoke with licensee Carolyn Smith and was told that she was giving up the license.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 208-7709
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021
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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