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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347002709
Report Date: 11/08/2021
Date Signed: 11/08/2021 09:53:52 AM

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:A TLC HOMEFACILITY NUMBER:
347002709
ADMINISTRATOR:POP, AURICAFACILITY TYPE:
740
ADDRESS:7338 CROSS DRIVETELEPHONE:
(916) 725-2008
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 4DATE:
11/08/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Aurica PopTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Jacob Williams arrived at the facility at 10:00 AM and met with Licensee Aurica Pop, to conduct an inspection proceeding the closure of the facility. A Notice of Facility Closure was received by the Regional Office with a facility closure date of 11/08/2021. At the time, the facility had zero (0) RCFE clients, but the facility is operating as a room and board with four (4) tenants.

License was forfeited to LPA at the time of visit. LPA informed Licensee that facility will be closed in the department's system effective 11/08/2021.

Exit interview was conducted with Licensee and a copy of this report was provided to the facility. The signature of Licensee on this form acknowledges receipt of this report.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Jacob WilliamsTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
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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