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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201429
Report Date: 12/20/2024
Date Signed: 12/20/2024 11:13:43 AM

Document Has Been Signed on 12/20/2024 11:13 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:KARUNA HOME CAREFACILITY NUMBER:
079201429
ADMINISTRATOR/
DIRECTOR:		CHONEY, TENZINFACILITY TYPE:
740
ADDRESS:861 HUMBOLDT STREETTELEPHONE:
(831) 332-7988
CITY:RICHMONDSTATE: CAZIP CODE:
94805
CAPACITY: 6CENSUS: 5DATE:
12/20/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Anita Sarna, CaregiverTIME VISIT/
INSPECTION COMPLETED:
10:40 AM
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On 12/20/24 around 10:15 AM, Licensing Program Analyst (LPA) L. Holmes arrived announced to conduct a Pre-licensing Inspection. Upon arrival, LPA was greeted by Anita Sarna, Caregiver (S1).

S1 contacted S2 by phone. LPA requested the new Licensee (S3) be present for the pre-licensing inspection but S3 is not available at this time.

LPA observed that facility's pre-licensing was incomplete and no deficiencies were cited. This report will be submitted to the Central Applications Unit (CAU) and a review of the application will be conducted.

Exit interview conducted and a copy of this report provided to Anita Sarna, Caregiver.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2024
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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