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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700764
Report Date: 08/22/2024
Date Signed: 08/22/2024 05:40:38 PM


Document Has Been Signed on 08/22/2024 05:40 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:SPLENDOR OAKS SENIOR LIVING 2FACILITY NUMBER:
312700764
ADMINISTRATOR:LEE, KEVINFACILITY TYPE:
740
ADDRESS:6056 BIG BEND DRTELEPHONE:
(916) 297-7141
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:6CENSUS: 5DATE:
08/22/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Maria CuciceaTIME COMPLETED:
05:15 PM
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On 8/22/24, Licensing Program Analyst (LPA) Kevin Mknelly arrived at the home and announced the reason for the visit. Administrator designee Maria Cucicea arrived to assist.

LPA and Admin designee discussed the plan of correction for citation written on 8/1/24. Admin designee expressed that a refund was not due to R1's responsible party (RP).

LPA and Admin designee discussed the accounting provided by all parties.

Licensee will email RP an accounting of all expenses and payments received by to date 8/23/24.

LPA will review the email summary and determine if further action is required.

As a result of today's visit no additional citations are delivered at this time.

Report reviewed and copy provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2024
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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