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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004197
Report Date: 05/13/2022
Date Signed: 05/13/2022 11:58:52 AM


Document Has Been Signed on 05/13/2022 11:58 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:OHANA HOSPITALITYFACILITY NUMBER:
347004197
ADMINISTRATOR:AGNES SUMAGITFACILITY TYPE:
740
ADDRESS:5117 HEATHER RANCH WAYTELEPHONE:
(916) 534-7707
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95742
CAPACITY:6CENSUS: 4DATE:
05/13/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Marcia MarinasTIME COMPLETED:
12:15 PM
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On 5/13/22 at 11:00am Licensing Program Analyst (LPA) conducted an unannounced inspection to ensure all plans of corrections (POC) from a previous inspection have been completed.

LPA met with newly appointment administrator Marcial Marinas who confirmed that he is present at the facility to meet the administrative needs of the facility. LPA reviewed all POC documents provided to LPA and found they meet the requirements to ensure all deficiencies at the facility have been corrected or in process of being corrected.

All Administrator documentation received and approved by LPA Gould.

All training materials required as part of the POC are present and staff have already begun training. LPA observed 8 hours of training for all current staff.

All documentation has been submitted for criminal record clearance of staff members.

All deficiencies have been cleared. Per California code of regulations, Title 22, there were no deficiencies observed or cited during today's inspection.

Exit interview conducted and a copy of the is report was left at the facility.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin GouldTELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:
DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/13/2022
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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