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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700907
Report Date: 12/05/2023
Date Signed: 12/05/2023 03:57:10 PM

Document Has Been Signed on 12/05/2023 03:57 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:HOPEFUL TOMORROW HOMES, LLCFACILITY NUMBER:
342700907
ADMINISTRATOR:ANDRADA, MONALYNFACILITY TYPE:
737
ADDRESS:12857 CHEROKEE LANETELEPHONE:
(916) 890-4282
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY: 4CENSUS: 3DATE:
12/05/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Jasmin SamsonTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct a case management visit due to Resident 1 (R1) calling the Regional Office on 12/05/2023 regarding receiving money. LPA met with lead facility staff Jasmin Samson.

LPA interviewed facility staff to discuss any incidents that may have happened with R1. Based on information learned from staff regarding R1, no health or safety concerns observed. LPA could not interview R1 due to R1 being out on an outing.

No deficiencies cited.

An exit interview held, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2023
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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