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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005373
Report Date: 12/15/2021
Date Signed: 12/15/2021 11:01:31 AM

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:SATUKI CARE HOMEFACILITY NUMBER:
347005373
ADMINISTRATOR:KAKUTA, MIDORIFACILITY TYPE:
740
ADDRESS:6240 FENNWOOD COURTTELEPHONE:
(916) 922-3098
CITY:SACRAMENTOSTATE: CAZIP CODE:
95831
CAPACITY:6CENSUS: 2DATE:
12/15/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Midori KakutaTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 12/15/21 at 9:30am to conduct a Case Management visit. LPA was met by Midori Kakuta and George Kakuta and the purpose of the visit was stated. This visit is being conducted as a result of a SOC341 and Incident Report that was received by Community Care Licensing (CCL). This information involved resident #1 (R1) who was possibly a victim of financial abuse from the Power of Attorney (POA).


LPA reviewed and received a copy of the bank statement dated 11/30/2020 and the emails between the facility and the Long Term care Ombudsman (LTCO) regarding this matter. The POA relocated the resident to another facility on 11/30/21 after giving facility a 10 day notice.

Based on the information and documentation received during this visit it is deemed that the facility staff is not at fault for the residents possible monetary loss.



Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. during this visit. An exit interview was conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria BrownTELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
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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