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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004284
Report Date: 02/14/2024
Date Signed: 02/14/2024 09:21:43 AM


Document Has Been Signed on 02/14/2024 09:21 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:SERENITY HOME CAREFACILITY NUMBER:
347004284
ADMINISTRATOR:LENUTA IOVAFACILITY TYPE:
740
ADDRESS:6558 DONEGAL DRIVETELEPHONE:
(916) 727-1248
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:4CENSUS: 0DATE:
02/14/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Lenuta IovaTIME COMPLETED:
09:30 AM
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On 02/14/24 Licensing Program Analyst (LPA) Cheyenne Ratajczak met with Licensee, Lenuta Iova to conduct an inspection proceeding the closure of the facility. Regional Office received a Notice of Facility Closure signed by the Licensee with a facility closure date of 01/15/2024. The facility had no residents upon sending Notice of Facility Closure to Regional Office.

LPA observed interior/exterior of the facility including common areas, dining room, kitchen area, closets, bedrooms and bathroom. LPA observed that there were no residents at the facility.

LPA informed Licensee that facility will be closed in the department's system effective today, 02/14/2024.

Exit interview was conducted with Licensee and a copy of this report was provided.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Cheyenne RatajczakTELEPHONE: (916) 969-7879
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2024
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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