342700652-3-11-2026-27-AS-CVAO-DS3QEZ-20260311120709

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342700652
Report Date: 03/11/2026
Date Signed: 03/11/2026 12:07:41 PM

Document Has Been Signed on 03/11/2026 12:07 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:	VISTA DE ROBLES		FACILITY NUMBER:	342700652
ADMINISTRATOR/ DIRECTOR:	BRANDY VALENCIA		FACILITY TYPE:	735
ADDRESS:	9847 FOLSOM BLVD		TELEPHONE:	(916) 368-7186
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95827
CAPACITY: 80		CENSUS: 78	DATE:	03/11/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Hailey Cross		TIME VISIT/ INSPECTION COMPLETED:	12:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPA) Christina Valerio and LPA Reza Jamaly arrived unannounced to conduct an annual required inspection. LPAs met with Assstant Administrator Johnathon Moore, and explained the purpose of the visit. LPAs were later met by current administrator Hailey Cross. Administrator forwarded LPA an email that was previously sent to indicate the change of administrator. LPAs toured the facility to ensure compliance with Title 22 regulations. LPAs observed four (4) resident bedrooms, all of which were clean, fully furnished, and without hazardous items. All resident rooms were observed to have a bathroom, which was observed to be clean and fully stocked with hygiene supplies (soap, paper towels, toilet paper). Common areas (hallways, staff conference room, resident group room, laundry area, activity room, and lounge area) were observed to be fully furnished, organized, and clean. LPAs observed the medication room to be locked and inaccessible to residents in care. Kitchen area was observed to be clean. The facility was observed to have an adequate food supply. LPAs observed kitchen staff serving smoothies and snacks in addition to meal prepping and cleaning after breakfast service. The fire extinguishers located in the hallways were observed to be fully charged with the last annual service conducted on 04/04/2025. The annual service tag also indicated that the fire Marshall came by to check the extinguishers on 03/06/2026. The facility temperature was set to a comfortable temperature of 70 degrees. All emergency exits were free from obstructions. LPAs observed the exterior plant, which was observed to have no hazardous items and multiple large areas for outdoor activities. LPAs observed five (5) resident files and five (5) staff files. All files were observed to be up to date with required annual documentation. Continues on LIC 809 - C...

NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Christina Valerio
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/11/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: VISTA DE ROBLES	FACILITY NUMBER: 342700652
	VISIT DATE: 03/11/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued from LIC 809

LPA Valerio obtained Administrator Hailey's administrator qualifications, active administrator certificate, and copy of the LIC 308 - Facility Designation

LPA Valerio requested the following annual documentation be sent to christina.valerio@dss.ca.gov: LIC 500, LIC 610, Copy of Surety Bond

Per California Code of Regulations (CCR) - no deficiencies were observed during the visit. An exit interview was held, and a copy of the report was provided.

NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Christina Valerio
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/11/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

LIC809 (FAS) - (06/04)

Page: 3 of 3