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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
342700927
Report Date:
08/05/2021
Date Signed:
08/06/2021 01:46:11 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:
AUGUSTUS ELDER CARE HOME, LLC
FACILITY NUMBER:
342700927
ADMINISTRATOR:
ARAGON, LEILANI
FACILITY TYPE:
740
ADDRESS:
5105 SCHUYLER DR
TELEPHONE:
(925) 922-4561
CITY:
CARMICHAEL
STATE:
CA
ZIP CODE:
95608
CAPACITY:
6
CENSUS:
4
DATE:
08/05/2021
TYPE OF VISIT:
Post Licensing
UNANNOUNCED
TIME BEGAN:
01:45 PM
MET WITH:
Leilani Aragon, Administrator
TIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Melana Llopis arrived unannounced at the facility on 08/05/2021 and conducted an annual inspection. Inspection report can be located on LIC809 - Visit date 08/05/2021- Annual/Random.
SUPERVISOR'S NAME:
Maribeth Senty
TELEPHONE:
(916) 263-4813
LICENSING EVALUATOR NAME:
Melana Llopis
TELEPHONE:
510-298-7052
LICENSING EVALUATOR SIGNATURE:
DATE:
08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/06/2021
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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