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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700540
Report Date: 02/05/2021
Date Signed: 02/05/2021 01:14:57 PM

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:JULIANA CARE HOMEFACILITY NUMBER:
342700540
ADMINISTRATOR:MURZAK, BORISFACILITY TYPE:
740
ADDRESS:10239 JULIANA WAYTELEPHONE:
(916) 362-1169
CITY:SACRAMENTOSTATE: CAZIP CODE:
95827
CAPACITY:4CENSUS: 0DATE:
02/05/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Boris Murzak, AdministratorTIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Michael Hood contacted Administrator, Boris Murzak, via face-time tele-visit to conduct a virtual inspection proceeding the closure of the facility. A Notice of Facility Closure was received by the Regional Office with a facility closure date of 2/5/2021. The visit was conducted via telephone due to COVID-19 and precautionary measures.

LPA observed interior/exterior of the facility, including back yard, living room, dining room, kitchen, bathroom, and 2 bedrooms. LPA observed that there were no residents at the facility.

LPA advised Administrator to mail the original License to the Regional Office and that the facility will be closed in the system as of 2/5/2021. A copy of this report has been emailed to the Administrator and the Administrator was advised that a signed copy of this report shall be submitted to CCLD within 10 days of receipt of this report.

Exit interview conducted.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2021
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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