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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
342700552
Report Date:
11/15/2021
Date Signed:
11/15/2021 02:47:23 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:
EDEN'S HOME CARE RCFE
FACILITY NUMBER:
342700552
ADMINISTRATOR:
ROOT, LINDZIE MARIE
FACILITY TYPE:
740
ADDRESS:
5917 KIFISIA WAY
TELEPHONE:
(916) 524-1280
CITY:
FAIR OAKS
STATE:
CA
ZIP CODE:
95628
CAPACITY:
6
CENSUS:
0
DATE:
11/15/2021
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
02:10 PM
MET WITH:
TIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Angela Hood arrived at the care home today to conduct a case management health and safety inspection. LPA met with the current renter of the home. There is currently a family renting the home that is not utilizing the home as a residential care facility for the elderly. The current renter invited LPA into the home to ensure there are no residents still residing in the home. LPA toured the home and did not observe any residents.
SUPERVISOR'S NAME:
Maribeth Senty
TELEPHONE:
(916) 214-0485
LICENSING EVALUATOR NAME:
Angela Hood
TELEPHONE:
650-676-0390
LICENSING EVALUATOR SIGNATURE:
DATE:
11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/15/2021
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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