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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340312282
Report Date: 11/22/2024
Date Signed: 11/22/2024 11:42:09 AM

Document Has Been Signed on 11/22/2024 11:42 AM - 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:SEGOVIA'S CARE HOME #2FACILITY NUMBER:
340312282
ADMINISTRATOR/
DIRECTOR:		SEGVOIA, DANIELFACILITY TYPE:
735
ADDRESS:7931 OAK AVENUETELEPHONE:
(916) 223-5315
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 0DATE:
11/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Nimfa Segovia, Licensee TIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Sabrina Calzada conducted an unannounced case management visit on 11/22/2024. This visit is to confirm ORDER TO LICENSEE/FACILITY FOR IMMEDIATE EXCLUSION FROM FACILITY FOR INDIVIDUAL (S1).

The facility is currently non-operational and there are (0) clients in care. Upon arriving to the facility, at 11:00 am, LPA contacted Licensee, Nimfa Segovia, by phone, and stated she had a letter to serve regarding a prior staff. Licensee stated she would meet LPA at the facility shortly

LPA met with Licensee at 11:25 am and again stated the purpose of visit. Facility understands this is an Immediate Exclusion effective 11/22/2024 and (S1) is excluded and cannot be allowed to work, live in, and/or have contact with clients in any residential facility licensed by the California Department of Social Services. Therefore, the Department orders the facility to remove (S1) from any contact with clients and not allow this employee to be physically present in the facility.

The facility has been non-operation since around 2016. The Licensee stated the name of (S1) is very vague and (S1) would have been employed on/around 2009 and for a short time, if ever. LPA to follow up and convey this information to department managers.

Exit interview conducted, a copy of this report was provided on this date, along with the above named letter/order. A signature on these forms acknowledges receipt of these forms.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024
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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