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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 585002962
Report Date: 12/11/2024
Date Signed: 12/11/2024 01:00:48 PM

Document Has Been Signed on 12/11/2024 01:00 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:M & L CAREHOME 2FACILITY NUMBER:
585002962
ADMINISTRATOR/
DIRECTOR:		AGATI, MAXIMFACILITY TYPE:
735
ADDRESS:2064 NEWPORT COURTTELEPHONE:
(530) 443-2958
CITY:PLUMAS LAKESTATE: CAZIP CODE:
95961
CAPACITY: 4CENSUS: 2DATE:
12/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Ayson Aguirre, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 12/11/2024 LPA Tryon visited the facility to conduct an annual visit. LPA met with Ayson Aguirre, Administrator/live-in staff, and Leah Aguirre, licensee/Administrator.

The home currently has two residents.

LPA toured the home with Administrator including common areas, kitchen, storage, bedrooms, bathrooms, hallways, laundry, garage, yard. The home has 4 single resident rooms and one staff room.
The house is new, very nicely furnished and clean. It is spacious with room for activities, etc.
Smoke and carbon monoxide detectors installed as well as fire extinguishers
.
LPA reviewed the CARE Plan with Administrator.

LPA reviewed 2 of 2 resident files, and 2 staff files.

LPA interviewed one staff.
LPA was not able to interview any residents as they were at day program.

At this time the home appears to be in good condition and meets regulations. No deficiencies were cited.

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
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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