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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003723
Report Date: 02/27/2025
Date Signed: 02/27/2025 02:48:17 PM

Document Has Been Signed on 02/27/2025 02:48 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:CHARIBEL JOSE CARE HOME, INC.FACILITY NUMBER:
347003723
ADMINISTRATOR/
DIRECTOR:		CHARIBEL JOSEFACILITY TYPE:
735
ADDRESS:5831 TREE HILL CTTELEPHONE:
(916) 332-5277
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY: 4CENSUS: 4DATE:
02/27/2025
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Charibel Jose TIME VISIT/
INSPECTION COMPLETED:
02:05 PM
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On 02/27/2025, Licensing Program Analyst (LPA) Cheyenne Ratajczak and Licensing Program Manager (LPM) Laura Munoz and Troy Ordonez met with Administrator Charibel Jose and ALTA California Regional Center representatives. Today's meeting was conducting over Microsoft Teams meeting to discuss the 3-day eviction request for Resident #1 (R1) from facility.

Today's meeting was to address the following issues:
  • 3-day eviction request from facility.
  • 30 day notice from facility
  • R1's current behaviors, concerns, and interventions.

The Facility agrees to do the following:
  • Incident reports are to be sent into Community Care Licensing (CCL) within 7 days of occurrence.
  • Administrator to send an update three (3) day notice to CCL for review
  • Administrator to rescind 30 day notice and reissue a new 30 day notice and send a copy to CCL.

Exit interview conducted. A copy of report was emailed to licensee. Licensee to review, sign, and return a signed copy of report to CCL.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2025
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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