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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455001493
Report Date: 08/09/2022
Date Signed: 08/09/2022 11:37:29 AM


Document Has Been Signed on 08/09/2022 11:37 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:LAVENDER HILLS ASSISTED LIVING LLCFACILITY NUMBER:
455001493
ADMINISTRATOR:COULTER, JANETFACILITY TYPE:
740
ADDRESS:1720 COLLYER DRIVETELEPHONE:
(530) 241-5121
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:15CENSUS: 0DATE:
08/09/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:44 AM
MET WITH:Jennifer Boss, AdministratorTIME COMPLETED:
01:00 PM
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on 08/09/2022-Licensing Program Analysts (LPAs) Misty Valencia and Shannon Diegoruelas met with Jennifer Boss, Administrator, (Admin) to conduct an inspection proceeding the closure of the facility. Regional Office received a Notice of Facility Closure with a facility closure date of 05/31/2022. The facility had thirteen (13) residents, who have all moved out to House #2.

LPAs observed interior/exterior of the facility and observed that there were no residents at the facility.

LPA obtained a copy of the license during today's inspection. LPA informed Admin that facility will be closed in the department's system effective today, 8/9/2022.

Exit interview was conducted with Admin and a copy of this report was emailed.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty ValenciaTELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2022
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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