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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803848
Report Date: 07/02/2024
Date Signed: 07/02/2024 09:05:16 AM


Document Has Been Signed on 07/02/2024 09:05 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:SUNSET GARDEN IIIFACILITY NUMBER:
496803848
ADMINISTRATOR:RELOTA, EDENFACILITY TYPE:
740
ADDRESS:1144 PRUNETREE CTTELEPHONE:
(707) 548-5753
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY:6CENSUS: 0DATE:
07/02/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Eden Relota (Licensee)TIME COMPLETED:
09:20 AM
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Licensing Program Analyst (LPA) Cuadra arrived at the home for the purpose of conducting a closure inspection pursuant to voluntary closure of this licensed Residential Care Facility for the Elderly. LPA arrived and was allowed in by the Licensee Eden Relota. LPA/Licensee toured the facility and licensee told LPA that the landlord are in the process of selling the home.

Today, LPA inspected all rooms, the exterior of the building and found no evidence that would suggest that any residents are residing on the premises. All clothing and personal items belonging to residents have also been removed.

The Licensee initiated this facility closure with plans for voluntary closure and did submit a closure plan. On 5/24/2024 LPA received a phone call from Licensee notifying CCL about their plan to close the facility. Per Licensee an eviction letter was given to five residents and their responsible parties regarding the facility's plan to close dated 5/24/24. All five residents were relocated. Closure of this facility has been finalized. Facility was closed effective 7/2/24. Licensee agreed to turn over the License to the Department not later than 7/5/24.

No deficiencies cited during today's visit.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:
DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2024
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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