<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
515002956
Report Date:
01/17/2024
Date Signed:
01/19/2024 11:11:26 AM
Document Has Been Signed on
01/19/2024 11:11 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 NORTH ASC
,
9835 GOETHE ROAD, SUITE 100
SACRAMENTO
,
CA
95827
FACILITY NAME:
ABUNDO'S RESIDENTIAL CARE
FACILITY NUMBER:
515002956
ADMINISTRATOR:
ABUNDO, EMMANUEL
FACILITY TYPE:
735
ADDRESS:
10191 HYACINTH WAY
TELEPHONE:
(408) 348-3453
CITY:
LIVE OAK
STATE:
CA
ZIP CODE:
95953
CAPACITY:
4
CENSUS:
0
DATE:
01/17/2024
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
09:30 AM
MET WITH:
Emmanuel Abundo and Nick Sosa
TIME COMPLETED:
10:35 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
PA Hiratsuka, conducted this announced visit. This facility does not have any residents at this time.
Due to computer issues a handwritten report was left.
No deficiencies cited.
SUPERVISORS NAME
:
Troy Ordonez
LICENSING EVALUATOR NAME
:
Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE
:
DATE:
01/19/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
1