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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701008
Report Date: 03/18/2022
Date Signed: 03/18/2022 11:48:03 AM


Document Has Been Signed on 03/18/2022 11:48 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:PLACE CALLED HOMEFACILITY NUMBER:
392701008
ADMINISTRATOR:VARGAS, BRANDIFACILITY TYPE:
740
ADDRESS:25820 MAGNOLIA AVETELEPHONE:
(714) 948-0381
CITY:ESCALONSTATE: CAZIP CODE:
95320
CAPACITY:11CENSUS: 0DATE:
03/18/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Nataley MartinezTIME COMPLETED:
11:45 AM
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On 3-18-22 at 11:00am, Licensing Program Analysts (LPAs) Michael Bilger and Maja Jensen arrived to conduct a case management for the proceeding of the facility closure. LPAs met with Licensee Nataley Martinez and explained the purpose of this visit. Regional office received information Licensee that all residents moved out of facility by 3-9-22.

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

LPA retrieved original license and informed Licensee that the facility will be closed in the system within one week. Licensee made aware that any existing allegations will continued to be investigated accordingly. A copy of this report was left with Nataley Martinez..

Link to survey for Facility Closure provided to Nataley Martinez

www.surveymonkey.com/r/facilityclosure


Exit interview conducted with Nataley.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2022
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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