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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002307
Report Date: 07/31/2024
Date Signed: 07/31/2024 03:27:13 PM


Document Has Been Signed on 07/31/2024 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



FACILITY NAME:ESTERA'S HOME CARE IIFACILITY NUMBER:
315002307
ADMINISTRATOR:NICULAI, ESTERAFACILITY TYPE:
740
ADDRESS:1744 WOODLEAF CIRCLETELEPHONE:
(916) 257-3621
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:5CENSUS: 0DATE:
07/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Leon NiculaiTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived to conduct the annual inspection. LPA met Leon Niculai during today's inspection. Currently there are no residents living at the home.

LPA toured the facility with Leon Niculai. LPA observed no one is living at the facility. At this time the administrator is not admitting residents to the home.

No deficiencies cited during today's inspection.

Exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:
DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2024
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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