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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700551
Report Date: 09/21/2020
Date Signed: 10/30/2020 10:46:57 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:CAMLU ASSISTED LIVINGFACILITY NUMBER:
392700551
ADMINISTRATOR:WHITTED, ALMAFACILITY TYPE:
740
ADDRESS:6037 N PERSHING AVETELEPHONE:
(209) 951-2030
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:96CENSUS: 71DATE:
09/21/2020
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Mark Cimino representing Ciminocare and Edward Barkett representing Atlas Senior Care TIME COMPLETED:
01:30 PM
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A conference call was scheduled on 9/18/2020 at 1:00PM.

Participants on the call were: Regional Manager (RM) Krystall Moore; Licensing Program Manager (LPM) Liza King; Licensing Program Manager (LPM) Czarrina Camilon-Lee; Licensing Program Analyst (LPA) Diego Escobar; Licensing Program Analyst (LPA) Ashley Boothe; Ombudsman Jill Hernandez; Ciminocare CEO Mark Cimino; Edward Barkett Altas Senior Care representative; Chris Coulter and Larry John Nov Pershing LLC owners.

The conference call was held to discuss recent add/change management company (ACMC).
RM and LPMs discussed with all parties the change of ownership procedures (CHOW). RM requested a lease back agreement and copy of CHOW notices to residents by close of business on Wednesday September 23, 2020.

Exit interview was conducted with Mark Cimino. Copy of the report sent to Mark via e-mail with a "read receipt" to verify the LIC 809 was received. Mark is to print out the report, and fax a signed copy to LPA at 916-263-4744.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ashley BootheTELEPHONE: (916) 708-7751
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2020
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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