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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700294
Report Date: 06/02/2023
Date Signed: 06/04/2023 10:37:29 AM

Document Has Been Signed on 06/04/2023 10:37 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:JASMINE-HALL IIIFACILITY NUMBER:
342700294
ADMINISTRATOR:MCCOLLOUGH, LYLEFACILITY TYPE:
735
ADDRESS:1601 FERRAN AVETELEPHONE:
(916) 424-3550
CITY:SACRAMENTOSTATE: CAZIP CODE:
95832
CAPACITY: 6CENSUS: 1DATE:
06/02/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:George HallTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced at the business address of the Jasmine Hall facilities at 2141 10th Ave Sac, Ca 95818 on 6/2/2023 at 2:00pm to Conduct a Case Management visit. LPA met with George Hall and stated the purpose of the visit. This visit is to discuss forfeiture of license(s).

On 4/6/23, LPA conducted a Case Management visit and issued a Notice of Violation (NOVL) due to the Department has not received applications for the licensed facilities. At that time, George Hall was informed that there was a change in the majority ownership interest which forfeited the license(s) for E.H. Star Care Homes.

A signed Notice of Operation in Violation of Law (NOVL) letter requires one of the following: 1. Submit an application for licensure; 2. Relocate individuals who require care and supervision from the operator or operator's staff within 15 days; 3. Cease operation.

Under Health and Safety code Sections 1508, 1568.03, 1569.10, or 1596.80, 1540, 1541, 1568.0823, 1569.40, 1569.41, 1596.89 and/or 1596.890, 1540.1, and California Code of Regulations, an unlicensed facility is subject to $200 per day civil penalty for the continued operation after the operator has been issued the Notice of Operation in Violation of Law and has not submitted a completed application as required.

From the issuance of the NOVL on 4/6/23 (56 days), the Department has not received any applications for the licensed homes. You, (E. H. Care Homes) are hereby assessed an Immediate civil penalty in the amount of $11,200.00.

Per California Code of Regulations (CCR) - Title 22, Division 6, Chapter 6, you are being provided a copy of the Civil Penalty Assessment (Unlicensed Facility) (LIC421A) An exit interview conducted, and a copy of the report and Civil Penalty Assessment (Unlicensed Facility) (LIC421A) was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE: DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2023
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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