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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000175
Report Date: 12/04/2024
Date Signed: 12/05/2024 02:06:33 PM

Document Has Been Signed on 12/05/2024 02:06 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CAJUCOM CARE HOME #1FACILITY NUMBER:
347000175
ADMINISTRATOR/
DIRECTOR:		EDILBERTO Z CAJUCOMFACILITY TYPE:
740
ADDRESS:3024 EASTERN AVETELEPHONE:
(916) 483-3033
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY: 11TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
12/04/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Edilberto Cajucom, Celia EsquilloTIME VISIT/
INSPECTION COMPLETED:
11:33 AM
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Licensing Program Analyst Holly Williams, Regional Manager Stephanie Daub, and Licensing Program Manager Czarrina Camilon-Lee attended a meeting through Microsoft Teams for Cajucom Care Home #1 and met with Edilberto Cajucom and Celia Esquillo. Sofia New could not attend.
Daub stated that we were allowing them to have an emergency license to operate until Sofia News application is approved.
Esquillo said Sofia New is now buying both facilities.
In an email from Edilberto Cajucom he mentioned that Licensing would move the residents. Czarrina Camilon-Lee stated that Community Care Licensing does not relocate residents and that Cajucom has to relocate their own residents.
Cajucom was informed that they have 60 days from the date of this meeting to get the application in, send out their 60 days notice and get approved.

When looking for Sofia News application it showed that there is no application submitted yet.
LPA Holly Williams will call Sofia New to get an update on the applications.

A copy of this report will be emailed to Edilberto Cajucom.
Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
Holly WilliamsTELEPHONE: 916-798-3161
DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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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