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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701514
Report Date: 05/01/2026
Date Signed: 05/01/2026 02:08:50 PM

Document Has Been Signed on 05/01/2026 02:08 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:SUMERLIN GUEST HOME 2FACILITY NUMBER:
342701514
ADMINISTRATOR/
DIRECTOR:		CALDEIRA, MARIA SOCORROFACILITY TYPE:
740
ADDRESS:8667 SUMERLIN CT.TELEPHONE:
(916) 304-3575
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 6CENSUS: 2DATE:
05/01/2026
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Ericson Serrano, LIcenseeTIME VISIT/
INSPECTION COMPLETED:
02:10 PM
NARRATIVE
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On 05/01/26, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to conduct health and safety checks and to obtain an update on the closing of this facility. LPA identified herself upon arrival, stated the purpose of the visit and asked to meet with the Designated Facility Administrator. Staff called the Licensee and Ericson Serrano arrived shortly after.

LPA conducted a tour of the facility. Two of the residents were sleeping, one was at the hospital, and this LPA interviewed the remaining resident (R1) about the notice of closure. R1 stated that no one had informed them of the closure. LPA requested a copy of R1's LIC 602 and observed that R1 had no diagnosis of cognitive impairment.

The Administrator, Maria Caldeira, provided this LPA with a copy of the Notice of Closure and told her that all the responsible parties and residents would be provided with a copy on 04/23/26. During this visit, this LPA called and spoke to 2 of the responsible parties for 2 of the residents in care. Both (F1 and F2) stated that they did not receive anything in writing about the facility closing. They stated that they were informed the facility was changing ownership. LPA clarified that the facility was going through the closure process, that someone had applied for a license to potentially take over the facility, however there were no guarantees that the application for the license would be approved, or that it would be approved by the closing deadline of 06/17/26.

While at the facility, a representative from a placement agency (A1) arrived to relocate one of the residents (R2). LPA interviewed the representative and learned that none of the 3 residents or their respective responsible parties were notified in writing about the closure, that they too were told that there was going to
NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Kimberly Viarella
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 05/01/2026 02:08 PM - It Cannot Be Edited


Created By: Kimberly Viarella On 05/01/2026 at 09:37 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SUMERLIN GUEST HOME 2
FACILITY NUMBER: 342701514

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/01/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/02/2026
Section Cited
CCR
87205(a)

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(a) The licensee...shall exercise general supervision over the affairs of the licensed facility... in conformance with these regulations and the welfare of the individuals it serves. The licensee did not meet the above requirement as evidenced by:
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Licensee will submit missing documents to CCL by close of business today.

Licensee provided closure plan and all assessments prior to this LPA leaving the building - this POC has been cleared.
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Based on interview and document review, Licensee agreed to submit closure plan and updated assessments/care plans by 2/22/26 04/24/26. This posed/es a potential threat to the health, safety, and personal rights of residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Stephen Richardson
NAME OF LICENSING PROGRAM MANAGER:
Kimberly Viarella
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/01/2026


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SUMERLIN GUEST HOME 2
FACILITY NUMBER: 342701514
VISIT DATE: 05/01/2026
NARRATIVE
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be a change of ownership. LPA requested the closure plan that was due on 04/22/26 and the updated assessments that were due on 04/24/26. The Licensee could not produce any of these documents upon request.

LPA has cited for the following during today's visit:
CCR 87205(a) Accountability of Licensee Governing Body
CCR 87468.2(a)(7) Additional Personal Rights of Residents in Privately Operated Facilities
CCR 87405(d) Administrator Qualifications


According to the California Code of Regulations, Title 22, no other deficiencies were observed or cited during today's visit, a copy of this report was provided along with APPEAL RIGHTS and an exit interview was conducted with Serrano.
NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Kimberly Viarella
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026
LIC809 (FAS) - (06/04)
Page: 5 of 5
Document Has Been Signed on 05/01/2026 02:08 PM - It Cannot Be Edited


Created By: Kimberly Viarella On 05/01/2026 at 11:42 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SUMERLIN GUEST HOME 2
FACILITY NUMBER: 342701514

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/01/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/02/2026
Section Cited
CCR
87405(d)

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Administrator Qualifications 87405
(d) The administrator shall have the qualifications specified in Sections 87405(d)(1-7)... (2) Knowledge of and ability to conform to the applicable laws, rules and regulations... The Licensee did not ensure the above requirement was met as evidence by:
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Licensee stated that all responsible parties and residents would be notified through email, phone call and letter regarding the facility closure. LPA to be copied on all the emails sent out. Copies of letters to go in resident files by close of business 05/02/26.
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Based on interviews with 2 responsible parties F1 and F2 along with the representative from the placement agency(A1) Responsible parties were not provided written notice of closure. This posed/es an immediate threat to the health, safety and personal rights of residents in care.
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Type A
05/01/2026
Section Cited
CCR87468.2(a)(7)

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(7) To fully participate in planning their care.... The licensee shall provide necessary information and support to ensure...
Based on observation and interview the Licensee did not ensure the above requirement was met as evidenced by
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Licensee has stated that they will supply the resident with written notification of the notice of closure with the R1 and answer any questions they may have, This will be completed by the close of business on 05/02/26.
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Based on an interview with R1, R1 was not notified of the facility closure in writing or verbally thus not providing them information regarding their care, this posed an immediate risk to the health safety and personal rights of residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Stephen Richardson
NAME OF LICENSING PROGRAM MANAGER:
Kimberly Viarella
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/01/2026


LIC809 (FAS) - (06/04)
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