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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005006
Report Date: 05/20/2021
Date Signed: 05/20/2021 04:41:26 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:NOVARA CARE HOMEFACILITY NUMBER:
347005006
ADMINISTRATOR:MARIE RIVERAFACILITY TYPE:
740
ADDRESS:9827 NOVARA WAYTELEPHONE:
(916) 459-6371
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY:6CENSUS: 0DATE:
05/20/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Marie Rivera, AdministratorTIME COMPLETED:
04:45 PM
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Licensing Program Analysts (LPA) Tung Truong arrived at this facility unannounced on 05/20/2021 at 4:00 PM to conduct an in-person inspection proceeding the closure of the facility. LPA met with administrator Marie Rivera.

LPA toured the facility with the administrator to ensure that there were no residents in care. LPA observed that there were no residents at the facility. The administrator stated she is surrendering her license and closed the facility for personal reasons.

LPA advised Administrator to mail the original License to the Regional Office and that the facility will be closed in the system as of 05/20/2021. LPA requested the administrator to send in a copy of the administrator certificate. LPA obtained a formal letter from the administrator stating her intention to close the facility.

Link to survey for Facility Closure provided to Marie Rivera.

www.surveymonkey.com/r/facilityclosure

Exit interview conducted and a copy of this report was given to the administrator.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2021
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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