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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700854
Report Date: 10/20/2021
Date Signed: 10/20/2021 12:51:16 PM

Document Has Been Signed on 10/20/2021 12:51 PM - 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:ALEXA'S ELDERLY CARE #2FACILITY NUMBER:
342700854
ADMINISTRATOR:ROZOLEANU, ALEXANDRAFACILITY TYPE:
740
ADDRESS:6905 LE HAVRE WAYTELEPHONE:
(916) 634-6304
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY: 6CENSUS: 4DATE:
10/20/2021
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Carmen Ion, Assisting AdministratorTIME COMPLETED:
11:50 AM
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Licensing Program Analysts (LPAs) Angela Hood and Michael Hood arrived at the care home today and met with the Assisting Administrator, Carmen Ion, to conduct an annual required and post licensing visit.

For more information on the post licensing visit please see LIC 809 dated 10/20/21.

No deficiencies cited for the post licensing visit.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2021
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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