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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
347004460
Report Date:
03/09/2022
Date Signed:
03/16/2022 10:30:55 AM
Document Has Been Signed on
03/16/2022 10:30 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
,
520 COHASSET RD., STE. 170
CHICO
,
CA
95926
FACILITY NAME:
HARMONY HOME CARE
FACILITY NUMBER:
347004460
ADMINISTRATOR:
JOANNA BROTNEI
FACILITY TYPE:
740
ADDRESS:
7900 BELLINGRATH DR.
TELEPHONE:
(916) 992-6032
CITY:
ELVERTA
STATE:
CA
ZIP CODE:
95626
CAPACITY:
6
CENSUS:
0
DATE:
03/09/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
10:26 AM
MET WITH:
Attempted Visit
TIME COMPLETED:
10:42 AM
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LPA Attempted to conduct an annual inspection. No one answered the door.
SUPERVISOR'S NAME:
Laura Munoz
TELEPHONE:
(916) 263-4743
LICENSING EVALUATOR NAME:
DeAnna Williams-Lyons
TELEPHONE:
(916) 212-3983
LICENSING EVALUATOR SIGNATURE:
DATE:
03/16/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/16/2022
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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