<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347002908
Report Date: 07/14/2022
Date Signed: 07/14/2022 11:49:28 AM


Document Has Been Signed on 07/14/2022 11:49 AM - 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:REBECCA'S GUEST HOMEFACILITY NUMBER:
347002908
ADMINISTRATOR:MORRIS, REBECCA C.FACILITY TYPE:
740
ADDRESS:9458 HOSPENTHAL WAYTELEPHONE:
(916) 602-7482
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 0DATE:
07/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Rebecca MorrisTIME COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to initially conduct a required 1-year visit on 7/14/22 at 11am. Upon arrival LPA met with Rebecca Morris and stated the purpose of the visit. Rebecca stated she is surrendering the license and there are no residents at this time.

During this visit LPA received the License from the Licensee and requested that the survey monkey be completed on a voluntary basis and very much appreciated.


LPA observed that there is no care and supervision being provided in the home at this time. The facility number will be closed as of todays date.


Here is the link which is also available online.
https://www.surveymonkey.com/r/facilityclosure
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria BrownTELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1