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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002708
Report Date: 05/05/2022
Date Signed: 05/05/2022 06:09:52 PM


Document Has Been Signed on 05/05/2022 06:09 PM - 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:LADY OF GRACE CARE FACILITYFACILITY NUMBER:
455002708
ADMINISTRATOR:MAYER, CELIA CFACILITY TYPE:
740
ADDRESS:277 EDINBURGH PLTELEPHONE:
(530) 226-1689
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:6CENSUS: 0DATE:
05/05/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
05:00 PM
MET WITH:Celia Mayer, AdministratorTIME COMPLETED:
05:31 PM
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Licensing Program Analyst (LPA) Misty Valencia met with Administrator, Celia Mayer, to conduct an inspection proceeding the closure of the facility. Regional Office received a Notice of Facility Closure with a facility closure date of 5/2/2022. The facility had five (5) residents, who have moved out. Admin has provided documentation of resident's current locations.

LPA observed interior/exterior of the facility, including front and back yard, common areas, dining room and kitchen area, closets, five (5) resident bedrooms, three (3) bathrooms. LPA observed that there were no residents at the facility.

LPA obtained a copy of the license during today's inspection. LPA informed Licensee that facility will be closed in the department's system effective today, 5/5/2022.

Exit interview was conducted with Licensee and a copy of this report was provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty ValenciaTELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:
DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2022
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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