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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701172
Report Date: 01/24/2025
Date Signed: 01/24/2025 11:16:40 AM

Document Has Been Signed on 01/24/2025 11:16 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:YOUNG AT HEART RCFE NO.5 INCFACILITY NUMBER:
342701172
ADMINISTRATOR/
DIRECTOR:		SISAYAN, ISAGANIFACILITY TYPE:
740
ADDRESS:8039 CAYMUS DRIVETELEPHONE:
(916) 681-3689
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY: 6CENSUS: 6DATE:
01/24/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Glenda MolinyaweTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Victoria Brown and Regional Manager (RM) Stephenie Doub arrived on 1/24/25 at 9:45am unannounced to conduct a Case Management visit regarding information received about possible illegal eviction of resident #1 (R1).

LPA and RM interviewed residents during this visit. R1 and Staff #1 (S1-R3) was interviewed.

LPA received copies of resident file documents.

The investigation revealed that the Licensee did not refuse to allow R1 to return to the facility.

Licensee indicated that R1 has not paid rent since December 13, 2024. R1 is still residing in the home.

Based on interviews the facility will receive an advisory note during this visit.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies observed or cited.

Exit interview held, copy of report given
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2025
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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