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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000922
Report Date: 03/08/2023
Date Signed: 03/08/2023 09:19:01 AM


Document Has Been Signed on 03/08/2023 09:19 AM - 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:CINDY CENDANA CARE HOMEFACILITY NUMBER:
347000922
ADMINISTRATOR:CINDY CENDANA GULESSERIANFACILITY TYPE:
740
ADDRESS:10108 MONTE VALLO COURTTELEPHONE:
(916) 854-2574
CITY:SACRAMENTOSTATE: CAZIP CODE:
95827
CAPACITY:6CENSUS: 5DATE:
03/08/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Ryan GulesserianTIME COMPLETED:
09:45 AM
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 3/8/23 at 8:30am, Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced health and safety inspection following the reported incident of injury and reported death of a resident. LPA met with Licensee Ryan Gulesserian and together conducted walk through of the home to ensure the health and safety of residents.

LPA observed 5 residents in care. All residents in care appeared clean, well groomed and in good health. LPA observed no health and safety concerns at the time of inspection.

LPA reviewed former resident file and observed the file to be completed an up to date.

Per California Code of Regulations, Title 22 there were no deficiencies cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin GouldTELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2023
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