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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005860
Report Date: 02/29/2024
Date Signed: 02/29/2024 12:45:22 PM


Document Has Been Signed on 02/29/2024 12:45 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:MCGREGOR HOME GARFIELDFACILITY NUMBER:
347005860
ADMINISTRATOR:LIZA SEGUBANFACILITY TYPE:
740
ADDRESS:3136 GARFIELD AVENUETELEPHONE:
(916) 692-5886
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 4DATE:
02/29/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Aileenette Calderon, CaregiverTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Angela Hood arrived unannounced at the care home today, 2/29/24, and met with Caregiver, Aileenette Calderon, to conduct a case management health and safety visit.

On 2/29/24, the Department was informed that the care home no longer has an Administrator. During today's visit, LPA observed care staff to be providing care to the residents. LPA spoke with Licensee via phone and was informed that they have another Administrator that will begin working full time at the care home. LPA verified that the Administrator has a current certificate #6033614740 with an expiration date of 2/9/2025. LPA informed Licensee to submit required Administrator documentation to the Department by 3/14/24.

No deficiencies are being cited. Exit interview conducted. A copy of report provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Angela HoodTELEPHONE: 650-676-0390
LICENSING EVALUATOR SIGNATURE:
DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/29/2024
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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