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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700491
Report Date: 09/21/2021
Date Signed: 09/21/2021 10:26:10 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:LOVE AND SERENITY IIFACILITY NUMBER:
342700491
ADMINISTRATOR:RATU P VUNIMATANAFACILITY TYPE:
740
ADDRESS:5942 PARK VILLAGE STTELEPHONE:
(916) 476-5595
CITY:SACRAMENTOSTATE: CAZIP CODE:
95822
CAPACITY:6CENSUS: 4DATE:
09/21/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Administrator, Anthony CamachoTIME COMPLETED:
10:45 AM
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On 9/21/2021 at 9:50am, Licensing Program Analyst (LPA) Tung Truong arrived unannounced to conduct a Proof of Correction (POC) Visit. LPA met with Administrator Anthony Camacho and explained the purpose of today’s visit.

LPA reviewed document submitted for plans of correction observed that the deficiencies cited on 09/17/2021 have been cleared.

*Deficiency cited under Title 22 Regulation 87411(a) and 87405(a) has been cleared. Licensee complied with the terms of the POC by POC due date.

Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
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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