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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
342700400
Report Date:
02/22/2024
Date Signed:
02/22/2024 02:27:28 PM
Document Has Been Signed on
02/22/2024 02:27 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 SOUTH ASC
,
9835 GOETHE ROAD, SUITE 100
SACRAMENTO
,
CA
95827
FACILITY NAME:
HEMPSTEAD HOME
FACILITY NUMBER:
342700400
ADMINISTRATOR:
ROODENBURG, FRANS
FACILITY TYPE:
740
ADDRESS:
3105 HEMPSTEAD RD
TELEPHONE:
(916) 485-7420
CITY:
SACRAMENTO
STATE:
CA
ZIP CODE:
95864
CAPACITY:
6
CENSUS:
5
DATE:
02/22/2024
TYPE OF VISIT:
POC
UNANNOUNCED
TIME BEGAN:
02:00 PM
MET WITH:
Milagros Dioso
TIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to follow up on a plan of correction developed on 1/29/24. LPA Moleski met with licensee Milagros Dioso and explained the purpose of the visit.
LPA Moleski cited this facility on 1/29/24 per 22 CCR Section
87303(e)(2) due to water temperatures below 105 degrees. LPA Moleski re-tested the water during this visit and observed a measurement of 115 degrees which is within the required range of 105 and 120 degrees. The plan of correction for that deficiency was cleared during this visit.
No deficiencies were cited during this visit. An exit interview was held and a copy of this report was left with Dioso.
SUPERVISOR'S NAME:
Stephen Richardson
TELEPHONE:
(916) 263-4746
LICENSING EVALUATOR NAME:
Vincent Moleski
TELEPHONE:
(559) 365-5294
LICENSING EVALUATOR SIGNATURE:
DATE:
02/22/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/22/2024
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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