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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340313161
Report Date: 09/21/2022
Date Signed: 10/05/2022 11:19:48 AM


Document Has Been Signed on 10/05/2022 11:19 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
CCLD Regional Office, 2525 NATOMAS PARK DR., STE 260
SACRAMENTO, CA 95833



FACILITY NAME:DEBORAH FILPULA FAMILY HOMEFACILITY NUMBER:
340313161
ADMINISTRATOR:FILPULA, DEBORAH M.FACILITY TYPE:
710
ADDRESS:10496 DREXEL COURTTELEPHONE:
(916) 366-3432
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY:5CENSUS: 6DATE:
09/21/2022
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Deborah Fipula, AdministratorTIME COMPLETED:
12:40 PM
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On September 21, 2022 at 11:30AM Licensing Program Analyst (LPA) Yuvi Diaz conducted an announced annual inspection. Deborah Fipula, Administrator assisted LPA Diaz with this inspection.

The home is a two-story home. Consist of 6 bedrooms, 4 bedrooms, dining room, kitchen, living room, large room for staff, and outside yard, LPA finished one domain from caretools. LPA Diaz will come back at a later time to complete annual inspection.

No deficiencies were noted at today's inspection. Exit interview was conducted with Debora Fipula, Administrator. A copy of this report will be emailed.
SUPERVISOR'S NAME: Rosa RodriguezTELEPHONE: (916) -66-1458
LICENSING EVALUATOR NAME: Yuvicela DiazTELEPHONE: 916-806-1364
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
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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