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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315001404
Report Date: 01/02/2025
Date Signed: 02/14/2025 03:27:06 PM

Document Has Been Signed on 02/14/2025 03:27 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:BROOKVIEW RCFE, INC.FACILITY NUMBER:
315001404
ADMINISTRATOR/
DIRECTOR:		JACOBSON, MARIVELFACILITY TYPE:
740
ADDRESS:2061 BUTTERFIELD LANETELEPHONE:
(916) 966-9370
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
01/02/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Marivel JacobsonTIME VISIT/
INSPECTION COMPLETED:
10:50 AM
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Licensing Program Analyst (LPA) Graham Gunby arrived on Thursday January 2, 2025 to conduct the unannounced annual inspection.

During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA Gunby reviewed client (5) and staff (1) files. All client files contained the required paperwork. All staff files contained the required paperwork and training.

LPA Gunby and Administrator Marivel toured the facility together to ensure the health and safety of clients in care. The areas toured included bedrooms (4), kitchen, bathrooms, laundry room, living room, front yard, back yard and garage. All chemicals and toxins were kept locked and inaccessible to clients. Facility has two fire extinguishers (one in the living room, one in hallway). In the areas toured, there were no health or safety violations observed.

No deficiencies cited. Exit interview conducted. A copy of this report was emailed to the Administrator.
Troy OrdonezTELEPHONE: (916) 263-4832
Graham GunbyTELEPHONE: (916) 827-6870
DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/02/2025
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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