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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002847
Report Date: 12/15/2022
Date Signed: 12/15/2022 01:51:51 PM

Document Has Been Signed on 12/15/2022 01:51 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:ADAMS RESIDENTIAL CARE SERVICES LLCFACILITY NUMBER:
345002847
ADMINISTRATOR:CAILING, ESTELITAFACILITY TYPE:
740
ADDRESS:7809 OLD AUBURN RDTELEPHONE:
(916) 390-6144
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 0DATE:
12/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Adam Dickey, CEO TIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced on 12/15/22 at 1:10 pm. LPA knocked on the door and no one answered. LPA tried both contact numbers of record and spoke to Adam Dickey, CEO, who arrived at the facility promptly. LPA completed today's report outside on the patio table and was wearing a surgical mask.

Adam stated there are currently no residents and they are still waiting on vendorization from Alta California Regional Center.

Adam expects paperwork to be completed by end of February 2023 and will notify the Department.

There are no clients currently at this location.

Exit interview. Copy of report to be emailed immediately following the inspection.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2022
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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