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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803539
Report Date: 10/21/2021
Date Signed: 10/21/2021 10:59:49 AM

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:TREE HAVEN ESTATEFACILITY NUMBER:
496803539
ADMINISTRATOR:VEGVARY, JULIUS & MERCEDESFACILITY TYPE:
740
ADDRESS:359 TREE HAVEN LANETELEPHONE:
(707) 328-1691
CITY:KENWOODSTATE: CAZIP CODE:
95452
CAPACITY:6CENSUS: 0DATE:
10/21/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Licensee, Mercedes VegvaryTIME COMPLETED:
11:05 AM
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Licensing Program Analyst (LPA) Erik Gonzalez-Campos arrived at Tree Haven Estate announced for a voluntary facility Closure, and met with the Licensee, Mercedes Vegvary. The facility was destroyed in the October, 2017 fires that affected Sonoma County. There have been no residents in care since 2017.

Community Care Licensing (CCL) was informed of the decision to sell the property and forfeit the license on August 24, 2021

The licensee initiated this facility closure. LPA inspected all rooms and the exterior of the building and found no evidence that would suggest that clients are residing on the premises.

Licensee will mail out license to the Regional Office. Facility will be closed effective October 22, 2021. Exit interview was conducted and a copy of this report was given to Licensee, Mercedes Vegvary.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Erik Gonzalez CamposTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
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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