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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002824
Report Date: 05/09/2022
Date Signed: 05/09/2022 03:10:08 PM


Document Has Been Signed on 05/09/2022 03:10 PM - 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:LIVING WATER THEFACILITY NUMBER:
345002824
ADMINISTRATOR:LAQUAGLIA, MARLANAFACILITY TYPE:
740
ADDRESS:7800 CLAYPOOL WAYTELEPHONE:
(916) 425-9266
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 3DATE:
05/09/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Marlana Laquaglia, LicenseeTIME COMPLETED:
02:35 PM
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On 5/09/2022 Licensing Program Manager (LPM) Troy Ordonez and Licensing Program Analyst (LPA) Bethany Mirlohi met with Licensee Marlana Laquaglia, and new home owners Grace Gunawan and Laurentius(Yudi) Widjaja via teleconference to discuss change of ownership of facility.

Grace Gunawan and Laurentius(Yudi) Widjaja closed escrow on the property on May 2nd and will be submitting a new application for new ownership of facility. Licensee understands during this process of change of ownership she remains the licensee and that her license is not transferable. Licensee understands that she must remain in control of property during the change of ownership process. LPM gave new owners contact information for application bureau and the administrator certificate office. Licensee will be out of town for 2 weeks and agrees to have an administrator designee during her absence.

Licensee agrees to the following:

1). Licensee will receive a lease back on the property so that she remains control of property. Lease back document to be submitted to CCL by Wednesday May 11, 2022.

2). Licensee to send administrator information of the designee that will be available during her absence and current LIC500. Documents to be sent into CCL by May 13, 2022.

LPA will forward a copy of this report to licensee. Licensee to review report, sign, and return a signed copy to CCL.

Exit interview conducted.

SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2022
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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