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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003426
Report Date: 03/12/2024
Date Signed: 03/12/2024 12:09:25 PM


Document Has Been Signed on 03/12/2024 12:09 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:DEL VISTA RESIDENTIAL CAREFACILITY NUMBER:
347003426
ADMINISTRATOR:SAEL, TATY L.T.FACILITY TYPE:
740
ADDRESS:78 DEL VISTA CIRCLETELEPHONE:
(916) 690-7243
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:6CENSUS: 5DATE:
03/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:03 AM
MET WITH:Taty SaelTIME COMPLETED:
12:15 PM
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On 3/12/24, at 10:03am, Licensing Program Analyst (LPA) Arvin Villanueva arrived at this facility unannounced to conduct a case management visit to amend a LIC 809-D issued during a previous case management visit on 1/24/24. LPA Villanueva met with Taty Sael, facility administrator and explained the purpose of this visit.

LPA Villanueva also conducted additional interview with Taty regarding R1 and requested copy of additional documents of R1.

Per title 22 no deficiencies being cited during this visit. An exit interview was conducted with Taty Sael, Administratro and a copy of this report and an amended LIC 809-D page were provided.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) -26-4700
LICENSING EVALUATOR NAME: Arvin VillanuevaTELEPHONE: 916-558-2130
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2024
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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