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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004573
Report Date: 02/14/2024
Date Signed: 02/14/2024 09:08:51 AM


Document Has Been Signed on 02/14/2024 09:08 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:PARKVIEW GUEST HOMEFACILITY NUMBER:
347004573
ADMINISTRATOR:ALLEN, DREW S.FACILITY TYPE:
740
ADDRESS:10390 JILLSON WAYTELEPHONE:
(916) 685-6129
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY:6CENSUS: 0DATE:
02/14/2024
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
07:48 AM
MET WITH:Melba AllenTIME COMPLETED:
09:20 AM
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Licensing Program Analyst (LPA) Christina Valerio arrived announced to the facility to conduct a Closure Visit. LPA Valerio was notified by Licensee/Administrator Melba Allen that they would like to close the business. LPA met with Licensee and explained the purpose of the visit.

LPA observed interior/exterior of the facility, including front and back yards, living room, activity room, dining room, kitchen, bathrooms, and all bedrooms. LPA observed that there were no residents at the facility.

LPA retrieved original license and informed Administrator that the facility will be closed in the system as of 02/15/2023.

Link to survey for Facility Closure provided to Licensee Melba Allen.

www.surveymonkey.com/r/facilityclosure

An exit interview was held, and a copy of this report was left with the Administrator.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2024
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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