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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002866
Report Date: 01/19/2023
Date Signed: 01/19/2023 05:06:59 PM


Document Has Been Signed on 01/19/2023 05:06 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:ROBERT CREEK VILLA IIFACILITY NUMBER:
345002866
ADMINISTRATOR:KING, MARICARFACILITY TYPE:
740
ADDRESS:8138 ROBERT CREEK COURTTELEPHONE:
(925) 567-8181
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 4DATE:
01/19/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:Maricar King, Administrator TIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met Maricar KIng, Administrator, and explained purpose of inspection. LPA observed a second caregiver, Apolinario "Nari" Macaraeg preparing dinner in the kitchen.

Prior to initiating today's inspection, LPA completed required COVID-19 Department protocols, wore a surgical mask and was screened per Covid-19 precautionary measures upon entering the facility.

This report is being generated to document that an annual inspection was conducted on 1/19/2023, on a separate report, and to clear a post-licensing inspection from being due in the system.

There are no deficiencies being issued today.

Exit interview. Copy of report left with Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2023
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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