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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347002709
Report Date: 11/23/2022
Date Signed: 11/23/2022 02:01:35 PM


Document Has Been Signed on 11/23/2022 02:01 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: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: 0DATE:
11/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Aurica Pop, Administrator TIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met with Aurica Pop, Administrator, and explained purpose of inspection.

Administrator stated she is currently not operating as a licensed facility; however, she would like to keep the license open. Currently, the location is operating as a room and board facility, with (3) tenants, and there is no license required.

Administrator stated she is taking a break from the business and hopes to starts operating again in the next year or so. Administrator stated annual fees are current. LPA observed a framed copy of the RCFE license.

LPA toured the interior of the facility and did not observe any RCFE residents. Of the (3) tenants, (1) tenant was present and the (2) tenants were visiting family.

The Infection Control Domain questions are not being completed at this time due to no RCFE clients. There are also no deficiencies being issued on this report.

LPA advised Administrator to inform CCLD if she is planning to accept any RCFE residents.

Exit interview. Copy of report provided to Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 11/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/23/2022
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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