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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803757
Report Date: 12/10/2020
Date Signed: 12/10/2020 04:04:50 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:PURPLE DOOR CARE HOME LLC, THEFACILITY NUMBER:
486803757
ADMINISTRATOR:DENNIS, RHONDAFACILITY TYPE:
740
ADDRESS:1200 GRANT STTELEPHONE:
(925) 812-4631
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:6CENSUS: 0DATE:
12/10/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Rhonda Dennis, Administrator/Licensee TIME COMPLETED:
03:45 PM
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Licensing Program Analyst K. Canela met with Rhonda Dennis, Administrator and Licensee, to complete a final walk through for Licensee-initiated Facility closure. Due to COVID – 19 precautions an in-person facility visit is not able to be conducted at this time.

Licensee stated they have not had any resident admissions; the facility has been licensed since 11/01/2018. Licensee was unable to locate the facility license to surrender to the Department. LPA conducted virtual walk through with Licensee to confirm no residents are present. LPA did not observe any postings. LPA will send out a forfeiture letter to Licensee and complete closure process.

LPA sent copy of report to Licensee for signature.
Signatures in file
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5079
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: (707) 588-5083
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2020
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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