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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347002709
Report Date: 11/27/2023
Date Signed: 11/27/2023 04:06:30 PM


Document Has Been Signed on 11/27/2023 04:06 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



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:
11/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Aurica Pop, AdministratorTIME COMPLETED:
04:05 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 the facility remains non-operational as a licensed facility; however, she would still like to keep the license open. Currently, the location remains operating as a room and board facility, with (2) tenants, and there is no license required.

Administrator hopes to possibly operate again in the next year. Administrator stated annual fees are current.
LPA toured the interior of the facility and did not observe any RCFE residents. Of the (2) tenants, (1) tenant was present and (1) tenant is running errands.

Administrator was advised to notify the Department if she is planning to accept any RCFE residents or close the license.

There are no deficiencies issued.

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: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/27/2023
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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