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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700343
Report Date: 03/05/2025
Date Signed: 03/05/2025 10:30:40 AM

Document Has Been Signed on 03/05/2025 10:30 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:BLESSED HOME FOR SENIORS IIFACILITY NUMBER:
342700343
ADMINISTRATOR/
DIRECTOR:		GATCHALIAN, M AURORAFACILITY TYPE:
740
ADDRESS:9961 DOVE SHELL WAYTELEPHONE:
(916) 685-4334
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
03/05/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Mika MantuparTIME VISIT/
INSPECTION COMPLETED:
10:40 AM
NARRATIVE
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Licensing Program Analyst (LPA) Arvin Villanueva conducted a case management visit in order to follow up on Licensing Fees. Presently, the facility has an outstanding balance of $1, 484. 00. LPA initially met with staff on duty, Mika Mantupar, and stated the purpose of this visit. The Administrator Aurora Gatchalian was notified and arrived shortly after.

On 7/3/2024, Community Care Licensing Division (CCLD) sent a bill with the annual licensing fees to the Licensee; however, the annual fees have not been paid as of this date. LPA Villanueva informed and explained to Licensee per (CCLD) regulations regarding Licensing Fees - The failure of an applicant or licensee to pay all applicable and accrued fees and civil penalties shall constitute grounds for denial or forfeiture of a license. In an effort to assist Licensee with a prompt payment, LPA provided the PIN number, which can be used to pay the balance immediately at CCLD website http://www.ccld.ca.gov/.

No citation was issued on this day, however, the following advisory was given: please pay the Annual Licensing Fees to prevent further action. This is not a citation but an advisory. Administrator agreed to pay fees on or by 3/6/2025.

An exit interview was conducted. This report was reviewed with Aurora and a copy of this report was left at the facility
Stephen RichardsonTELEPHONE: (916) 263-4700
Arvin VillanuevaTELEPHONE: 916-208-0023
DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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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