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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317001251
Report Date: 03/25/2022
Date Signed: 03/25/2022 10:14:03 AM


Document Has Been Signed on 03/25/2022 10:14 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:GRANITE SPRING CARE HOMEFACILITY NUMBER:
317001251
ADMINISTRATOR:TANYA FOKSHAFACILITY TYPE:
740
ADDRESS:5636 MONTCLAIR CIRCLETELEPHONE:
(916) 632-7473
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:6CENSUS: 0DATE:
03/25/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Natalya Foksha, LicenseeTIME COMPLETED:
10:25 AM
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Licensing Program Analysts (LPAs) Michael Hood and Talwinder Bains met with Licensee, Natalya Foksha, to conduct an inspection proceeding the closure of the facility. Regional Office received a Notice of Facility Closure signed by the Licensee with a facility closure date of 3/25/2022. The facility had no residents upon sending Notice of Facility Closure to Regional Office.

LPAs observed interior/exterior of the facility, including front and back yard, common areas, dining room and kitchen area, closets, laundry room, garage, staff room, 2 bathrooms, and 4 bedrooms. LPAs observed that there were no residents at the facility.

LPAs obtained a copy of the license during today's inspection. LPAs informed Licensee that facility will be closed in the department's system effective today, 3/25/2022.

Exit interview was conducted with Licensee and a copy of this report was provided.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: 916-531-7341
LICENSING EVALUATOR SIGNATURE:
DATE: 03/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/25/2022
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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