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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920022
Report Date: 08/28/2024
Date Signed: 08/28/2024 01:35:51 PM

Document Has Been Signed on 08/28/2024 01:35 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:BMJ GARCIA CARE HOME 4FACILITY NUMBER:
315920022
ADMINISTRATOR/
DIRECTOR:		GARCIA, MARILOUFACILITY TYPE:
735
ADDRESS:8401 TRINIDAD WAYTELEPHONE:
(916) 612-5030
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY: 4CENSUS: 0DATE:
08/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Precy Dicoy, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct an annual inspection. During today's inspection LPA met with Precy Dicoy. Currently there are no clients residing at the facility. Facility is waiting for regional center vendorized.

LPA toured the facility and observed 4 client rooms, 2 bathrooms, common living spaces, kitchen and garage area. No immediate health and safety issues observed in the facility. Administrator agrees to inform LPA when first client is admitted.

No deficiencies cited today and copy of report provided.

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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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