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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700202
Report Date: 08/08/2024
Date Signed: 08/08/2024 02:08:18 PM


Document Has Been Signed on 08/08/2024 02:08 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:VILLAGE AT HERITAGE PARK, THEFACILITY NUMBER:
342700202
ADMINISTRATOR:KENT MULKEYFACILITY TYPE:
740
ADDRESS:2001 ROSE ARBOR DRIVETELEPHONE:
(916) 216-8958
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:108CENSUS: DATE:
08/08/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Antoinette Edwards, Executive DirectorTIME COMPLETED:
02:15 PM
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On August 8, 2024, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to conduct an unannounced weekly on-site visit regarding the Stipulation the facility currently has. LPA met Antoinette Edwards, Executive Director (ED) and explained the purpose of the visit.

This is the first Bi-Monthly visit resulting from a Stipulation and Order. LPA discussed getting off Probation early due to the facility no longer has a Memory Care Unit. The ED was informed that the facility will not be getting off Probation early and will last until 2025. LPA will inform ED if documents that were submitted monthly are still required.

LPA informed facility that once change of Ownership is complete, a new license will be generated and mailed to the facility. At this time, LPA conducted a walk through of the facility and found facility to be in compliance with the Stipulations and Order.

Per California Code of Regulations, Title 22, no citations were issued. A copy of this report was given to Barbara
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2024
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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