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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003247
Report Date: 04/15/2024
Date Signed: 04/15/2024 12:19:34 PM


Document Has Been Signed on 04/15/2024 12:19 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:EMILY'S GUEST HOMEFACILITY NUMBER:
347003247
ADMINISTRATOR:TINTAS, MARIAFACILITY TYPE:
740
ADDRESS:7437 KANAI AVENUETELEPHONE:
(916) 745-3711
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:6CENSUS: 0DATE:
04/15/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Licensee- Maria TintasTIME COMPLETED:
12:25 PM
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On 04/15/24 Licensing Program Analyst (LPA) Cheyenne Ratajczak met with Licensee, Maria Tintas to conduct an inspection proceeding the closure of the facility. Regional Office received a Notice of Facility Closure signed by the Licensee with a facility closure date of 04/19/24. The facility had zero (0) residents upon sending Notice of Facility Closure to Regional Office.

LPA conducted a tour of the interior and exterior of the facility. Areas toured included but not limited to four (4) residents bedrooms, one (1) bathroom, kitchen, and common areas. LPA observed that there were no residents living in the facility.

LPA informed Licensee that facility will be closed in the department's system effective today, 04/15/24.

Exit interview was conducted with Licensee and a copy of this report was provided.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Cheyenne RatajczakTELEPHONE: (916) 969-7879
LICENSING EVALUATOR SIGNATURE:
DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/15/2024
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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