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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701141
Report Date: 04/24/2023
Date Signed: 04/25/2023 09:13:42 AM

Document Has Been Signed on 04/25/2023 09:13 AM - 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:MIRACLE CARE HOMEFACILITY NUMBER:
502701141
ADMINISTRATOR:CASILLAS, MARICELFACILITY TYPE:
735
ADDRESS:1112 MUIRSWOOD WAYTELEPHONE:
(209) 688-1181
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY: 4CENSUS: 0DATE:
04/24/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Maricel CasillasTIME COMPLETED:
11:00 AM
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Unannounced post licensing visit made out to this facility on 04/24/2023 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator, Maricel Casillas, who was briefly interviewed at this time.
It was learned that this facility does not have any residents at this time. The facility designated Administrator, Maricel Casillas, was still in the process of becoming vendorized through Valley Mountain Regional Center. As a result, no residents have been placed at this facility at this time.
This post licensing visit was conducted in conjunction with the annual visit as well.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2023
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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