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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001254
Report Date: 01/29/2021
Date Signed: 03/03/2021 09:57:39 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:GOLDIN CARE 1FACILITY NUMBER:
347001254
ADMINISTRATOR:DANIELLE E HAZZIEZFACILITY TYPE:
740
ADDRESS:108 REMINGTON DRIVETELEPHONE:
(916) 983-1721
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:6CENSUS: DATE:
01/29/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:24 PM
MET WITH:Sandra StarbuckTIME COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Konnor Leitzell held a conference call between Licensing Program Manager (LPM) Troy Ordonez and Sandra Starbuck.

Purpose of this meeting was to discus Sandra Starbuck's intent to sell, and to inform CCLD of an applicant that is in the works to take over facility.

LPA conducted exit interview and thanked Sandra Starbuck for her time.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Konnor LeitzellTELEPHONE: (916) 708-9618
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2021
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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