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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 575001676
Report Date: 12/01/2021
Date Signed: 12/01/2021 04:26:43 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:MODERN CARE AND LIVING, LLCFACILITY NUMBER:
575001676
ADMINISTRATOR:SILVESTRE, RAMONFACILITY TYPE:
740
ADDRESS:2472 STARLING LANETELEPHONE:
(916) 239-8948
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY:6CENSUS: 0DATE:
12/01/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:22 PM
MET WITH:Ramon Silvestre, LicenseeTIME COMPLETED:
04:23 PM
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Licensing Program Analyst (LPA) Jill Nakagawa conducted an unannounced Case Management- closure inspection of Modern Care and Living, LLC on 12/01/2021. This visit is in regards to the voluntary closure of this facility. The licensee has submitted the facility license to the department. LPA toured the facility from the outside with Licensee, Ramon Silvestre and observed no sign of clients residing at the facility. All client items have been removed and licensee states, there were no clients at the time of closure. The facility will be closed effective, 12/1/2021.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill NakagawaTELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021
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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