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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317001644
Report Date: 01/14/2025
Date Signed: 01/14/2025 04:30:42 PM

Document Has Been Signed on 01/14/2025 04:30 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MARCELLA GREEN FAMILY HOMEFACILITY NUMBER:
317001644
ADMINISTRATOR/
DIRECTOR:		GREEN, LINFACILITY TYPE:
735
ADDRESS:11742 JONES STREETTELEPHONE:
(530) 863-8866
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY: 6CENSUS: 3DATE:
01/14/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Licensee, Marcella GreenTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Managers (LPMs) Troy Ordonez, Laura Munoz and Licensing Program Analyst (LPA) Graham Gunby conducted a Case Management visit. LPM/LPA met with Licensee, Marcella Green.

On 01/14/2025, Alta California Regional Center (ACRC) notified the department that a mold sample has been taken from this facility and identified the facility has elevated levels of fungal spores which have been noted as airborne, toxic and may cause serious health risk. Due to the mold findings, ACRC will be relocating the current (3) three residents in care to another location today, 01/14/2025.

The licensee has been advised that no other residents shall be admitted to this facility until the licensee has provided the department with documentation that the toxic mold has been removed.

Citations will not be issued on this report as they are issued and documented on complaint #: 59-AS-20241213093239.

//Exit Interview

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Graham Gunby
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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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