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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701545
Report Date: 03/05/2025
Date Signed: 03/05/2025 02:55:58 PM

Document Has Been Signed on 03/05/2025 02:55 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:FARAI CARE CENTERFACILITY NUMBER:
342701545
ADMINISTRATOR/
DIRECTOR:		JACKSON, ANTONIOFACILITY TYPE:
735
ADDRESS:12415 WHEAT RIDGE DRIVETELEPHONE:
(661) 858-4069
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95742
CAPACITY: 4CENSUS: 0DATE:
03/05/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:20 PM
MET WITH:Antonio JacksonTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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Announced prelicensing Inspection visit was made by Licensing Program Analyst (LPA) Kimberly Viarella to this facility on 03/05/25. LPA identified herself upon arrival, stated the purpose of the visit, and asked to speak with the Designated Facility Administrator. LPA met with Antonio Jackson and a brief interview followed.

LPA conducted a prelicensing visit on 02/21/25 and all was in compliance except the for the ramps at the facility. The facility replaced the ramps and this LPA conducted an inspection to ensure that they were not blocking doorways and that there was an adequate landing spot in front of each entryway. All was in compliance at the time of inspection. Component III was completed during the meeting on 02/21/25 and the facility is ready for licensing.

A copy of this report was provided and an exit interview conducted.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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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