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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340317573
Report Date: 08/25/2021
Date Signed: 08/25/2021 11:11:29 AM

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:TRENTWICK PLACE SENIOR CARE HOMEFACILITY NUMBER:
340317573
ADMINISTRATOR:CAROLYN F. SMITHFACILITY TYPE:
740
ADDRESS:2600 TRENTWICK CT.TELEPHONE:
(916) 418-4341
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 0DATE:
08/25/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Landlord, Carolyn SmithTIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Melana Llopis arrived at the facility announced to conduct a final walk through of the facility which will be closing as of 08/25/2021.
LPA met with landlord Carloyn Smith and toured the facility together.

Landlord informed the Regional Office of the closure prior to notifying residents. Official closing date is 08/25/2021.

LPA and landlord toured the facility together and inspected the following: living room, kitchen, bedrooms, bathrooms, backyard and garage.
LPA observed no residents in the home.

A copy of the license was obtained.
LPA informed Licensee that facility will be closed in the department's system effective today, 08/25/2021.

Exit interview was conducted with Landlord and signature was received. A copy of this report will be provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melana LlopisTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
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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