<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002831
Report Date: 02/02/2024
Date Signed: 02/02/2024 03:42:11 PM

Document Has Been Signed on 02/02/2024 03:42 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:PEOPLE'S CARE KRANS COURTFACILITY NUMBER:
345002831
ADMINISTRATOR:BRITT, AMANDAFACILITY TYPE:
735
ADDRESS:8530 KRANS COURTTELEPHONE:
(909) 287-3557
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY: 4CENSUS: 3DATE:
02/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:09 PM
MET WITH:Administrator- Amanda BrittTIME COMPLETED:
03:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 02/02/24 Licensing Program Analyst (LPA) Cheyenne Ratajczak and Licensing Program Manager (LPM) Laura Munoz arrived at the facility unannounced to conduct a required 1-year annual inspection. LPA and LPM met with Administrator Amanda Britt, and explained the purpose of the visit.

LPA, LPM and caregiver conducted a tour of the interior and exterior of the facility. Areas toured included but not limited to: resident rooms, bathrooms, laundry rooms, kitchen, dining room, medication room and common areas. LPA observed residents in the common areas with staff.

LPA and LPM conducted a file review of three (3) resident and two (2) staff files. All files had the required documents present in files.

During the time of visit LPA Ratajczak was having technical difficulties. LPA and LPM will return at a later date to complete annual inspection.

Exit interview conducted and a copy of the report was emailed to Administrator Amanda Britt.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1