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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700726
Report Date: 11/30/2022
Date Signed: 11/30/2022 11:29:22 AM

Document Has Been Signed on 11/30/2022 11:29 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:SWEET HOME OF ROCKLIN IIFACILITY NUMBER:
312700726
ADMINISTRATOR:LOPEZ, DOINAFACILITY TYPE:
740
ADDRESS:1622 ALBATROSS WAYTELEPHONE:
(916) 781-9170
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY: 6CENSUS: 4DATE:
11/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Doina LopezTIME COMPLETED:
11:35 AM
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On 11/30/22, LPA Mknelly arrived to do an annual inspection and was informed that LPA Williams- Lyons had completed an annual inspection on 11/21/22. LPA was shown the report of the visit.

LPA followed covid precautions prior to visit. LPA was screened upon arrival.

LPA reviewed the new PIN.

The home is clean and odor free with residents receiving identified care.

No deficiencies cited.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2022
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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