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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 052701150
Report Date: 08/14/2024
Date Signed: 08/23/2024 12:55:49 PM

Document Has Been Signed on 08/23/2024 12:55 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KAREN CARES HOMEFACILITY NUMBER:
052701150
ADMINISTRATOR/
DIRECTOR:		PUENTE, KARENFACILITY TYPE:
735
ADDRESS:2378 VISTA DEL LAGOTELEPHONE:
(209) 584-9047
CITY:VALLEY SPRINGSSTATE: CAZIP CODE:
95252
CAPACITY: 4CENSUS: 4DATE:
08/14/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Karen Puente TIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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A case management meeting was conducted today on August 14, 2024 via Microsoft Teams with the Sacramento South Regional Office at 1:00 PM. Present in the meeting were Licensing Program Manager Czarrina Camilon-lee and Licensing Program Analyst Avelina Martinez; VMRC representatives: Robert Fernandez; and facility representative Karen Puente.

Change within a license process was explained during this meeting. In addition, Valley Mountain Regional Center (VMRC) application change process was explained.

Issues discussed during this meeting were the following:
  1. LLC expedited application status (change will take up to three business days). Application was submitted on August 09, 2024, which application is still pending.
  2. Unlicensed care concern discussed.
Per California Code of Regulations (CCRs) - Title 22 no deficiencies are being cited during this visit. An exit interview was conducted with Karen Puente, and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2024
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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