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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700792
Report Date: 11/03/2021
Date Signed: 11/03/2021 02:31:15 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:AMERICAN RIVER RESIDENTIAL CARE, LLCFACILITY NUMBER:
342700792
ADMINISTRATOR:JOLENE S SUFACILITY TYPE:
740
ADDRESS:124 HILLSWOOD DRIVETELEPHONE:
(916) 716-5431
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:6CENSUS: 4DATE:
11/03/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator- Jolene Su TIME COMPLETED:
01:30 PM
NARRATIVE
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On November 3, 2021, a office meeting was held on this day in the Sacramento North Regional Office via Microsoft Teams, due to COVID 19 precautions. The purpose of this meeting was to discuss the facility’s intent to close due a change of ownership and closure process. On October 21 , 2021. Jolene Su, The Chief Executive Officer (CEO), of American River Residential Care LLC., dba American River Residential Care, LLC (342700792) notified the department of her intent to close the license. Present in the meeting was Licensing Program Manager (LPM) Troy Ordonez, Licensing Program Analyst (LPA) Sarena Keosavang, Administrator/CEO Jolene Su.

Issues discussed during the meeting were:
· Section 87224 of the California Code of Regulations
· Health and Safety Code Section 1569.682(a)(2).
· Change of Ownership
· 60-day notice for change of use of the facility
· Notification Requirements (Letter of Intent to close)
· CEO responsibilities
· Appointing a new administrator

Licensee agreed to do the following:
· CCLD will be provided copies of the eviction notices given to residents and their responsible party.
· Administrator was advised that if the waiver is approved a final walk through is mandatory to close out the facility. It was also advised that fees are current and there are no outstanding balances.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiencies were cited during this visit. An exit interview was conducted with Administrator/ CEO. A copy of this report was provided via email and an electronic email read receipt confirms receiving these documents. Administrator Jolene Su will sign the document and send signed copy to LPA, Sarena Keosavang at sarena.keosavang@dss.ca.gov.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
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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