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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700704
Report Date: 05/29/2024
Date Signed: 05/29/2024 02:59:48 PM


Document Has Been Signed on 05/29/2024 02:59 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:A HEARTY CARE HOME IFACILITY NUMBER:
342700704
ADMINISTRATOR:CLARDY, MARIA JFACILITY TYPE:
740
ADDRESS:5794 SPENLOW WAYTELEPHONE:
(916) 339-6440
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:6CENSUS: DATE:
05/29/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:13 PM
MET WITH:Caregiver, Cef GalopeTIME COMPLETED:
03:15 PM
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On May 29, 2024, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to conduct a case Management Visit to see if resident was doing well. LPA met with Caregiver Cef Galope, and explained the reason for the visit.

The reason for the visit is to see if the residents previous landlord pay the over payment he was issued. The previous landlord received an overpayment and must pay the amount of $10,000. back.

The facility is providing what the resident needs. The resident can now shower and use the restroom without any problems.

No problems or issues. No citations issued.

An exit interview was conducted and a copy of this report was given to Cef.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/29/2024
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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