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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001879
Report Date: 10/13/2021
Date Signed: 10/13/2021 05:17:38 PM

Document Has Been Signed on 10/13/2021 05:17 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:ED DAVID CARE HOME #1FACILITY NUMBER:
347001879
ADMINISTRATOR:MARINA DAVIDFACILITY TYPE:
735
ADDRESS:7125 CANAVERAL WAYTELEPHONE:
(916) 332-2218
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY: 6CENSUS: 5DATE:
10/13/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Marta Blanco, administrator; Max Woodford, Licensee Representative; Johnny Xiong, Alta Manager; Rowena Lopez, Alta Manager; Sasha Gomez, Alta Service Coordinator; Laura Munoz, Licensing Program ManagerTIME COMPLETED:
05:15 PM
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On 10/13/2021 Licensing Program Analyst (LPA) Williams organized informal office meeting with Ed David Care Home #1 representatives, Alta Regional Center representatives, and Community Care Licensing representatives to discuss current issues with client R1 at Ed David Care Home #1.

Attendees are
  • Marta Blanco, Administrator of Ed David Care Homes
  • Max Woodford, Licensee Representative
  • Johnny Xiong, Alta Manager
  • Rowena Lopez, Alta Manager
  • Sasha Gomez, Alta Service Coordinator
  • Laura Munoz, Licensing Program Manager
  • Jacob Williams, Licensing Program Analyst

During the meeting, the licensee representative stated that at this time, the home is unable able to meet the needs of the resident. R1 is currently in the emergency room at hospital and licensee representative advised that when R1 is discharged from the emergency room, the facility will be refusing to take R1 back in the home. LPM Munoz advised the facility representative that if the facility refuses to bring R1 back to the facility, citations may be issued due to an unlawful eviction.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Jacob Williams
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2021
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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