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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700831
Report Date: 07/31/2024
Date Signed: 07/31/2024 11:28:16 AM


Document Has Been Signed on 07/31/2024 11:28 AM - 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:HONEST LIVINGFACILITY NUMBER:
342700831
ADMINISTRATOR:TRAN, VINHFACILITY TYPE:
740
ADDRESS:9449 CHEVERNY WAYTELEPHONE:
(916) 425-8161
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY:6CENSUS: 4DATE:
07/31/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Krist Tran and Lisa SaephanTIME COMPLETED:
11:36 AM
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An unannounced case management visit made out to the facility on 07/31/2024 at 10:10 AM, by Licensing Program Analyst Pang Lee who was met by caregiver Barbara Rubio who then called the administrator VinhTran. The administrator arrived approximately 15 mins later and joined the visit. The current census is 4 with 1 facility staff during today’s visit.

LPA Lee explained the purpose of this case management visit was to interview resident 1 (R1) in regards to a compliant control # 27-AS-20240417144857 that is unrelated to this facility. During today’s visit LPA Lee also collected MAR for the month of June 2024.

Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:
DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2024
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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