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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700670
Report Date: 11/22/2024
Date Signed: 11/22/2024 04:49:26 PM

Document Has Been Signed on 11/22/2024 04:49 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:LATER YEARS SENIOR CARE HOMEFACILITY NUMBER:
342700670
ADMINISTRATOR/
DIRECTOR:
ORNELLAS, MARITESFACILITY TYPE:
740
ADDRESS:14 ARARAT CTTELEPHONE:
(916) 538-6096
CITY:SACRAMENTOSTATE: CAZIP CODE:
95831
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
11/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:30 PM
MET WITH:Maryvic FelizardoTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct a case management visit. LPA Moleski spoke with facility administrator Marites Ornellas over the phone and explained the purpose of the visit. Ornellas said caregiver Maryvic Felizardo could sign this report in her absence.

This visit is to confirm immediate exclusion orders for a staff member (S1).

Ornellas acknowledged that S1 is excluded effective immediately, which means that S1 cannot be allowed to work, live in, and/or have contact with clients in any residential facility licensed by the California Department of Social Services. Therefore, the Department orders this facility to remove S1 from any contact with clients and not allow this employee to be physically present in the facility.

Ornellas said that S1 has not been working at this facility since at least 2018. Ornellas agreed to remove S1 from this facility's Guardian roster as soon as possible.

No deficiencies were cited during this visit. An exit interview was held with Felizardo. A copy of this report and the immediate exclusion notice were left with Felizardo. A signature on this report acknowledges receipt of these documents.
Stephen RichardsonTELEPHONE: (916) 263-4746
Vincent MoleskiTELEPHONE: (559) 365-5294
DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024
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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