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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002812
Report Date: 11/18/2024
Date Signed: 11/18/2024 01:28:53 PM

Document Has Been Signed on 11/18/2024 01:28 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:BLESSED HOMECARE 2 ROSEVILLEFACILITY NUMBER:
315002812
ADMINISTRATOR/
DIRECTOR:		ARGANA, FERDINANDFACILITY TYPE:
740
ADDRESS:4100 SHORTHORN WAYTELEPHONE:
(209) 834-4040
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY: 6CENSUS: 6DATE:
11/18/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Baby QuinteroTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 11/18/2024 at 10:30 AM, a Non-Compliance Conference was held at the Sacramento North Regional Office located at 9835 Goethe Road Suite 100, Sacramento CA 95827. The purpose of this meeting is to discuss the high volume of citations and a substantiated complaint. The following facilities are involved because they are owned by Licensee: BLESSED HOMECARE #342700911; BLESSED HOMECARE 2 ROSEVILLE # 315002812; and BLESSED HOMECARE 3 # 345920062.

Present in the meeting was Licensee, Baby Quintero, Facility Representative Leriza Arambulo, Regional Manager (RM) Alycia Rayner, Licensing Program Manager (LPM) Anthony Perez, LPM Troy Ordonez, Licensing Program Analyst (LPA) Cassandra Mikkelson, LPA Cassie Yang, LPA Cheyenne Ratajczak, and LPA Kerry Hiratsuka.

Issues discussed during the meeting were:
• High volume of Type A and Type B citations
• Substantiated Complaint
• Fire Safety issues
• Supervision issues
• Administrators lack oversight.
• Reporting requirements
• Communication breakdown
• Criminal record clearance
• Resident files are incomplete
• Food Service
• Licensee not completing Plan of Correction correctly and timely
• Licensee/Administrator accountability

The licensee was in agreement with the drafted non-compliance plan as outlined in LIC 9111. An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2024
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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