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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700704
Report Date: 06/13/2024
Date Signed: 06/13/2024 02:02:19 PM

Document Has Been Signed on 06/13/2024 02:02 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/
DIRECTOR:		CLARDY, MARIA JFACILITY TYPE:
740
ADDRESS:5794 SPENLOW WAYTELEPHONE:
(916) 339-6440
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY: 6CENSUS: 4DATE:
06/13/2024
TYPE OF VISIT:Case Management - IncidentANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:17 PM
MET WITH:Paulette, CaregiverTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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On June 13, 2024, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to conduct a case management visit. LPA met with Paulette and informed her the reason for the visit.

LPA received an email from the administrator wanting to discuss Resident #1 (R1).
R1 has lived in the for about a month. Lately, R1 had been displaying behaviors that's not welcome. The administrator wants to discuss what can be done. Administrator wants to meet at another location for the discussion. We will meet at Starbucks near the facility.
No citations given . This report was given to Paulette.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
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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