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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003949
Report Date: 07/05/2024
Date Signed: 07/05/2024 01:46:07 PM


Document Has Been Signed on 07/05/2024 01:46 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:HOLY FAMILY HOMEFACILITY NUMBER:
347003949
ADMINISTRATOR:JACKSON, CRISINAFACILITY TYPE:
740
ADDRESS:1440 HOOD ROADTELEPHONE:
(916) 532-7078
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:0CENSUS: 4DATE:
07/05/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Gloria DulayTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct a closure visit. LPA Valerio met with current administrator Gloria Dulay. The facility Holy Family Home went through a Change of Ownership. Holy Family Holy was closed effective 04/24/2024. The new facility operating at this licensed is Elixir Care Home and currently holds an active license with CDSS effective 04/25/2024.

Licensee/Administrator for Holy Family Home Crisina Jackson is currently on vacation and unable to come to the facility.

Administrator Gloria worked for Holy Family Home and stated Crisina closed for retirement.

LPA Valerio obtained a copy of the license for Holy Family Home.

LPA Valerio provided a survey link for Crisina Jackson to complete.

  https://www.surveymonkey.com/r/facilityclosure

An exit interview was held, and a copy of the report was provided.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:
DATE: 07/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/05/2024
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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