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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700887
Report Date: 07/27/2023
Date Signed: 07/27/2023 01:39:30 PM

Document Has Been Signed on 07/27/2023 01:39 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:EMMA & JOYCE DIALA UNIQUE HOMEFACILITY NUMBER:
342700887
ADMINISTRATOR:DIALA, MANUELFACILITY TYPE:
735
ADDRESS:7354 ALDEN WAYTELEPHONE:
(916) 821-4214
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY: 4CENSUS: 4DATE:
07/27/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Emmanuel DialaTIME COMPLETED:
02:00 PM
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On 07/27/2023 at 12:40 PM, Licensing Program Analyst (LPA) Pang Lee arrived at the facility unannounced to conduct a case management. LPA Lee explained the purpose of the visit. The purpose of today’s visit is due to the regional office receiving notification that the facility has bed bugs.

At 1:00 PM, administrator Emmanuel called pest control and pest Control Representative stated that they came out to service the facility on 07/25/2023 to treat the bedbugs. It was also confirmed that the facility has a pest control contract with Official Pest Prevention on 10/01/2021 to current. Administrator also provided LPA Lee with pest control contract document and bed bug service on 07/25/2023. At 1:10 PM, LPA Lee inspected all client bedrooms with administrator Emmanuel, LPA Lee did not observe any bed bugs in any client bedrooms.



No deficiencies were observed during this visit. An exit interview was held, and a copy of the report was given to Administrator Emmanuel.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2023
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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