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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003508
Report Date: 02/22/2021
Date Signed: 02/22/2021 04:45:18 PM

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:MEADOWS GUEST HOME, THEFACILITY NUMBER:
347003508
ADMINISTRATOR:GRACE FAUNDOFACILITY TYPE:
740
ADDRESS:10374 JILLSON WAYTELEPHONE:
(916) 271-2075
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY:6CENSUS: 0DATE:
02/22/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Grace FaundoTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Anthony Tuck conducted a case management virtual inspection on 02/22/2021 via facetime video call due to due to licensee/administrator Grace Faundo has informed CCL to cease operation of facility due to the property owner selling the property. Licensee submitted facility closure plan to CCL as well as provided residents in care 60 day eviction notice on 11/29/2020, as required. There were no resident in care, and resident were relocated during 60 day eviction period LPA inspected facility virtually with administrator to ensure there were no remaining signs of operation. There are no residents or overt signs of any residents being provided care and supervision. LPA confirmed facility closure. LPA received a list of locations for each resident new address location from Grace via email on 02/22/2021 with copy of eviction notice that was given to the residents..

LPA requested the license to be mailed to the Community Care License (CCL) Regional Office. The Facility is closed effective 02/22/2021. Due to the aforementioned, facility closure shall be processed in CCL database.

Link to survey for Facility Closure provided to Grace Faundo.

www.surveymonkey.com/r/facilityclosure

ver84grace@yahoo.com


Exit interview conducted and a copy of this report was emailed to the administrator with a read receipt. Licensee will send a signed copy of LIC 809 back to LPA via email.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (209) 242-5200
LICENSING EVALUATOR NAME: Anthony TuckTELEPHONE: (916) 708-6203
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2021
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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