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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
587003428
Report Date:
09/11/2024
Date Signed:
09/11/2024 12:56:00 PM
Document Has Been Signed on
09/11/2024 12:56 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 RESIDENTIAL CARE 2
FACILITY NUMBER:
587003428
ADMINISTRATOR/
DIRECTOR:
GUANZON, LORENA
FACILITY TYPE:
735
ADDRESS:
1727 SHORELINE DRIVE
TELEPHONE:
(530) 751-7532
CITY:
MARYSVILLE
STATE:
CA
ZIP CODE:
95901
CAPACITY:
6
CENSUS:
DATE:
09/11/2024
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
10:55 AM
MET WITH:
Lorena Guanzon
TIME VISIT/
INSPECTION COMPLETED:
01:05 PM
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LPA Hiratsuka conducted this unannounced annual visit. LPA toured the facility with Licensee/Administrator Lorena Guanzon.
This facility has three shared resident rooms and one staff room. The staff room has a full private bathroom. There is one full common bathroom. The main entrance opens to a sitting area and in the back of the facility is another sitting area along with dining and kitchen. There is a laundry room that leads to the garage. All areas toured did not have any health and safety concerns.
A couple of topics were discussed.
No deficiencies were observed.
SUPERVISORS NAME
:
Troy Ordonez
LICENSING EVALUATOR NAME
:
Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/11/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/11/2024
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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