425801205-1-13-2025-29-AS-EMIR-DCVTPG-20250113135420

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 425801205
Report Date: 01/13/2025
Date Signed: 01/13/2025 01:54:30 PM

Document Has Been Signed on 01/13/2025 01:54 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	CARNATE BOARD & CARE #3		FACILITY NUMBER:	425801205
ADMINISTRATOR/ DIRECTOR:	JEAN SARMIENTO		FACILITY TYPE:	740
ADDRESS:	831 WEST PERSHING STREET		TELEPHONE:	(805) 260-9941
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93458
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS:	DATE:	01/13/2025
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:40 PM
MET WITH:	Jean Sarmiento, Administrator		TIME VISIT/ INSPECTION COMPLETED:	01:15 PM

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Community Care Licensing received an email on 1/13/25 from licensee/administrator, Jean Sarmiento, stating they have no residents as of January 4, 2025.

Licensing Program Analyst (LPA) Erika Miller arrived to conduct a closure visit. The RO will close out the facility as of 1/13/2025. LPA toured the facility and did not observe any residents, and it did not appear any residents were residing in the facility.

LPA conducted exit interview provided a copy of the report.

Kelly Burley	TELEPHONE: (805) 562-0413
Erika Miller	TELEPHONE: (805) 450-0283
	DATE: 01/13/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025

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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