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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701119
Report Date: 05/05/2022
Date Signed: 05/05/2022 11:22:49 AM


Document Has Been Signed on 05/05/2022 11:22 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:ELEGANT CARE ASSISTED LIVING FACILITYFACILITY NUMBER:
502701119
ADMINISTRATOR:BHINDER, JAGTAR SFACILITY TYPE:
740
ADDRESS:2108 DOS PASSOS WAYTELEPHONE:
(209) 665-5121
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY:6CENSUS: 0DATE:
05/05/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator Jagtar BhinderTIME COMPLETED:
12:00 PM
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LPA Jason Lund arrived at the above address and met with Administrator Jagtar Bhinder. Administrator Jagtar Bhinder is turning closing the facility and the facility never did have residents in care. LPA Lund walked the facility and no residents resided at the facility. LPA Lund received the License from Administrator Jagtar Bhinder and the facility is now closed.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
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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