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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803959
Report Date: 11/18/2021
Date Signed: 11/18/2021 11:06:38 AM

Document Has Been Signed on 11/18/2021 11:06 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:SPECIAL CARE 2FACILITY NUMBER:
486803959
ADMINISTRATOR:AUJLA, HARJITFACILITY TYPE:
735
ADDRESS:436 AMBER DRIVETELEPHONE:
(707) 981-1987
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY: 4CENSUS: 4DATE:
11/18/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Administrator, Harjit AujlaTIME COMPLETED:
11:20 AM
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On 11/18/2021 Licensing Program Analisyt (LPA) Walters arrived at this facility to conduct a Case Management visit, and was greeting by Administrator, Harjit Aujla. LPA conducted an inspection to ensure a staff (listed as S1) on LIC 811 understood they could no longer work or be present at the facility per a Default Decision and Order issued by the State on Nov 15th and effective Nov 25th. Copy of D&O was left, Licensee/Administrator understood. Staff was not working for facility any longer.

No citations cited during today's visit.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Katrina Walters
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2021
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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