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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 585002569
Report Date: 01/16/2025
Date Signed: 01/16/2025 01:32:56 PM

Document Has Been Signed on 01/16/2025 01:32 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:GUANZON'S RESIDENTIAL CARE #3FACILITY NUMBER:
585002569
ADMINISTRATOR/
DIRECTOR:
GUANZON, LORENAFACILITY TYPE:
735
ADDRESS:5932 VINE COURTTELEPHONE:
(530) 741-0891
CITY:MARYSVILLESTATE: CAZIP CODE:
95901
CAPACITY: 4CENSUS: 4DATE:
01/16/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Reyna Ecleo and Lezlie PinatTIME VISIT/
INSPECTION COMPLETED:
01:36 PM
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LPA Hiratsuka, conducted this unannounced annual visit. LPA toured the facility with Caregiver Reyna Ecleo. House Manager Lezlie Pinat arrived during this visit.

The main entrance opens to a sitting room on the left. To the right is a doorway leading to the kitchen and to the right of the kitchen is a second sitting area, shared resident room, and door leading to the backyard. The kitchen has a door leading to the garage. In the back of the first sitting area is a hallway leading to two private resident rooms, a full common bathroom, and a caregiver room. The caregiver room has a full private bathroom. In the backyard there is a locked shed. There are locked cabinets for medications, confidential files, and chemicals. Food supply and personal protection equipment meets regulations.

two staff files were reviewed
two resident files were reviewed.

Several topics were discussed.


No deficiencies cited.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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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