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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003870
Report Date: 02/20/2024
Date Signed: 02/20/2024 01:36:54 PM


Document Has Been Signed on 02/20/2024 01:36 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:PALMERA CARE HOMEFACILITY NUMBER:
347003870
ADMINISTRATOR:COSTEA, ANDREIFACILITY TYPE:
740
ADDRESS:7748 BLACK SAND WAYTELEPHONE:
(916) 677-1078
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY:6CENSUS: 5DATE:
02/20/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Licensee- Andrei CosteaTIME COMPLETED:
01:45 PM
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 02/20/24 an office meeting was held at the Sacramento North Regional Office at 9835 Goethe Road, Suite 100. Present in the meeting was Licensing Program Managers (LPM) Laura Munoz, Licensing Program Analyst (LPA) Cheyenne Ratajczak and Talwinder Bains, Licensee Andrei Costea and potential Licensee Richard Millene.


The following topics were covered during today's meeting:
  • Change of ownership.
  • New application process as potential Licensee already initiated the application process through CAB.

Licensee agreed to do the following:
  • Submit copies of written notices provided to each resident or his or her legal representative of the
licensee's intent to see the facility at least 30 days prior to the transfer of the property or business.
  • Licensee agrees and understands that they are still accountable for the facility until the licensure has been approved.

At this time, no deficiencies are being cited.

Exit interview conducted, and a copy of the report was provided.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Cheyenne RatajczakTELEPHONE: (916) 969-7879
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2024
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