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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005361
Report Date: 08/22/2024
Date Signed: 08/22/2024 02:51:01 PM


Document Has Been Signed on 08/22/2024 02:51 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:SUMMERSET ASSISTED LIVINGFACILITY NUMBER:
347005361
ADMINISTRATOR:DANIELLE BARRYFACILITY TYPE:
740
ADDRESS:2341 VEHICLE DRTELEPHONE:
(916) 330-1300
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY:135CENSUS: DATE:
08/22/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Victoria Olivarez, Marketing DirectorTIME COMPLETED:
03:00 PM
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On 8/22/24 at 1:30pm, Licensing Program Analyst (LPA) Arvin Villanueva arrived unannounced at this facility to conduct a case management visit for the purpose of delivering an Order to Licensee/Facility of Immediate Exclusion from Facility. LPA Villanueva intially met with facility Receptionist, Gabriella Mendoza. The Administrator, Danielle Barry (ADM) was informed of the visit over the phone but is out of the facility during this visit. ADM gave permission to the facility Marketing Director, Victoria Olivares, to receive the documents and sign this report.

LPA explained the purpose of today’s visit. Staff_1 (S1) and Staff_2 (S2) were excluded as a result related to this facility. LPA explained to ADM that S1 and S2 be immediately excluded from this facility upon receipt of the exclusion letters. Per interview of ADM, S1 and S2 no longer employed at this facility.

LPA Villanueva served, via hand deliver, the Order to Licensee/Facility of Immediate Exclusion from Facility letter and Declaration of Service document to Victoria Olivares.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed and cited during today's visit.

Exit interview was conducted with Victoria Olivares and a copy of this report was provided at the conclusion of this visit.

SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Arvin VillanuevaTELEPHONE: 916-208-0023
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2024
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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