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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700915
Report Date: 11/15/2023
Date Signed: 11/21/2023 03:14:55 PM


Document Has Been Signed on 11/21/2023 03:14 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:ROBUST CARE HOME, LLCFACILITY NUMBER:
392700915
ADMINISTRATOR:UBALDO, YASHMINFACILITY TYPE:
740
ADDRESS:1627 MERIDIAN STREETTELEPHONE:
(650) 653-1608
CITY:MANTECASTATE: CAZIP CODE:
95337
CAPACITY:4CENSUS: 4DATE:
11/15/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Yashmin UbaldoTIME COMPLETED:
02:00 PM
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Unannounced post licensing visit made out to this facility on 11/15/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Yashmin Ubaldo, at this time. A brief interview was conducted with the facility designated Administrator at this time.
It was learned that this facility was also vendorized through Valley Mountain Regional Center (VMRC) to be able to accept and retain up to (4) Level 4I residents at any given time.
Current census was 4 residents.
There were no residents under the care of hospice or home health at this time according to statements made by the facility designated Administrator.
Tour of this facility was conducted.

This post licensing visit was conducted in conjunction with the annual visit. All file reviews for the facility staff and residents were conducted per the annual visit.

There were no deficiencies observed or cited during today's post licensing visit.

Exit Interview
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Charlie YangTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2023
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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