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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701263
Report Date: 10/18/2024
Date Signed: 10/18/2024 11:24:37 AM

Document Has Been Signed on 10/18/2024 11:24 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:MAPLE HAVEN INC.FACILITY NUMBER:
342701263
ADMINISTRATOR/
DIRECTOR:		OBASOHAN, JOHNFACILITY TYPE:
735
ADDRESS:7562 TWILIGHT DR.TELEPHONE:
(408) 859-7285
CITY:SACRAMENTOSTATE: CAZIP CODE:
95822
CAPACITY: 4CENSUS: 0DATE:
10/18/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:John ObasohanTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 10/18/24 at 10:45am Licensing Program Analyst (LPA) Kevin Gould arrived at Maple Haven Inc. for the purpose of conducting a Plan of Correction inspection. LPA met with Licensee, John Obasohan and together conducted a tour of the home.

LPA observed all corrections to be completed. All outdoor hazards have been removed. the facility is clean safe, sanitary and in good repair at the time of inspection. All bedrooms checked, screes repaired and all furnishings are operating as designed with no observed broken drawers.

POC clearance letters generated and a copy of this report was left at the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2024
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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