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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000958
Report Date: 05/16/2022
Date Signed: 05/16/2022 11:39:35 AM


Document Has Been Signed on 05/16/2022 11:39 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:GRANNY'S COTTAGEFACILITY NUMBER:
347000958
ADMINISTRATOR:ADALBERTH BANCUFACILITY TYPE:
740
ADDRESS:7717 DEANTON COURTTELEPHONE:
(916) 729-9319
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 4DATE:
05/16/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Albert Bancu, Administrator
Dorina Ploscariu, Licensee		TIME COMPLETED:
11:00 AM
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On 5/16/2022 Licensing Program Manager (LPM) Troy Ordonez and Licensing Program Analyst (LPA) Bethany Mirlohi met with Licensee Dorina Ploscariu, and administrator/potential new licensee Albert Bancu via teleconference to discuss change of ownership of facility.

Administrator stated he is in the process of submitting his new application into Centralized Application Bureau. Licensee will remain the owner of the home and administrator will be the new licensee. 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. LPA and LPM provided licensee and administrator with CCL contact information.

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: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2022
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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