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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004744
Report Date: 01/08/2021
Date Signed: 01/08/2021 10:29:12 AM

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:ANA HOME CAREFACILITY NUMBER:
347004744
ADMINISTRATOR:AVRAM, CASIANFACILITY TYPE:
740
ADDRESS:7084 CANEVALLEY CIRCLETELEPHONE:
(916) 459-5338
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:6CENSUS: 0DATE:
01/08/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Cassian AvramTIME COMPLETED:
10:30 AM
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On 1/8/21. Licensing Program Analyst (LPA) Kevin Mknelly conducted a video call inspection with Licensee, Casian Avram at approximately 10 AM.
LPA was unable to meet at the facility due to current circumstances.

The purpose of the inspection was to confirm that there are no residents in care at the facility.

In July 2020, all residents had moved from the home and licensee has not admitted any residents. Since July 2020, the licensee has retained their license until deciding in August of 2020 to relinquish their licence.

Licensee submitted the written request to the department. The request was dated 12/8/20. It was received in the regional office on 12/21/20 and was then forwarded to LPA on 1/5/20.

The inspection found that only family members of the licensee currently live in the home. The home is in process of sale for a private residence.

As a result of this inspection, no violations were found.

Unable to obtain signature. Signature present on hard copy in file. LPA sent a copy of report for Licensee to sign. Licensee to send a signed copy back to CCL.

SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2021
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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