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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005632
Report Date: 11/16/2022
Date Signed: 11/16/2022 12:12:09 PM


Document Has Been Signed on 11/16/2022 12:12 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:ESPINOZA CARE HOME 2FACILITY NUMBER:
347005632
ADMINISTRATOR:ESPINOZA,ALFREDO/MIRANDAFACILITY TYPE:
735
ADDRESS:380 ARCADE BLVDTELEPHONE:
(916) 544-9003
CITY:SACRAMENTOSTATE: CAZIP CODE:
95815
CAPACITY:4CENSUS: 4DATE:
11/16/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:57 AM
MET WITH:Ronil AuisonTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Avelina Martinez arrived at this facility unannounced on 11/16/2022 at 10:30 AM to conduct a case management visit. LPA met with Ronil Auison and explained the purpose of the visit.

The purpose of the visit is to follow up on an incident report received on 11/10/2022. Resident 1 (R1) relocation is pending LPA Martinez will follow up with the eviction process. In addition, the facility has update R1's care and supervision plan. An exit interview was conducted and copy of this report was given to the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2022
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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