347000922-3-5-2025-27-AS-KVIA-DEGRJY-20250305120443

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 347000922
Report Date: 03/05/2025
Date Signed: 03/05/2025 12:04:55 PM

Document Has Been Signed on 03/05/2025 12:04 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:	CINDY CENDANA CARE HOME		FACILITY NUMBER:	347000922
ADMINISTRATOR/ DIRECTOR:	CINDY CENDANA GULESSERIAN		FACILITY TYPE:	740
ADDRESS:	10108 MONTE VALLO COURT		TELEPHONE:	(916) 854-2574
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95827
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 5	DATE:	03/05/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:00 AM
MET WITH:	Cindy Cendana		TIME VISIT/ INSPECTION COMPLETED:	08:19 AM

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Unannounced Annual 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 Cindy Cendana and a brief interview followed. LPA presented the Administrator with a list of documents to be collected during the visit:

· LIC 500: Personnel Report

· LIC 308: Designation of Administrative Responsibility

· LIC 309: (for any LLC or Corp) if applicable

· LIC 402: Surety Bond, if applicable

· LIC 610E: Emergency Disaster Plan

· Copy of Liability Insurance

LPA noted the Administrator's certificate #7034585740, expired on 12/4/24 and this LPA checked to verify that she had provided all of the necessary recertification materials and was waiting for them to be processed so her new certificate could be sent to her (status; pending).

LPA compared Guardian roster to LIC 500 provided by the Administrator. All staff were cleared and the facility was in compliance at the time of inspection.

LPA inspected 3 resident rooms. All had the required furniture, furnishings, and lighting to be in compliance at the present time. LPA also viewed staff quarters as depicted on facility sketch.

The LPA inspected the kitchen. All knives and sharps were locked and inaccessible to residents in care. The

Stephen Richardson	TELEPHONE: (916) 263-4746
Kimberly Viarella	TELEPHONE: (916) 809-5764
	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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CINDY CENDANA CARE HOME	FACILITY NUMBER: 347000922
	VISIT DATE: 03/05/2025

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food supply was adequate for 2-day perishable and 7-day nonperishable.

LPA inspected a total of 2 bathrooms. Each contained soap, paper towels, and trash cans as required. All showers had the required non-slip surfaces. Hot water was measured and in compliance at 112.1 degrees Fahrenheit.

The fire extinguisher was last serviced on 12/19/24 by Fire Code Safety Equipment and was in compliance at the time of inspection.

The LPA observed medications were stored in a locked cabinet in the kitchen and inaccessible to residents in care. LPA reviewed storage and dosing procedures A review of the First Aid kit by the LPA found it to be complete and in compliance.

The exterior of the building was inspected by the LPA. There were no bodies of water present and the yard was completely fenced in. There were also sitting areas in shaded locations for residents to enjoy. All window screens ad gutters were in good repair at this time.

LPA observed all of the folowing were posted: activity calendar, menu calendar, facility license, administrator's certificat,e IF YOU SEE SOMETHING, SAY SOMETHING sign, along with resident rights.

LPA conducted a review of 3 staff and 2 resident files. All were in compliance at the time of this inspection.

According to the California Code of Regulations, Title 22, no deficiencies were observed or cited during today's visit. A copy of this report was provided.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly Viarella	TELEPHONE: (916) 809-5764
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

LIC809 (FAS) - (06/04)

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