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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
342700400
Report Date:
02/15/2024
Date Signed:
02/15/2024 11:22:14 AM
Document Has Been Signed on
02/15/2024 11:22 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
SACRAMENTO SOUTH ASC
,
9835 GOETHE ROAD, SUITE 100
SACRAMENTO
,
CA
95827
FACILITY NAME:
HEMPSTEAD HOME
FACILITY NUMBER:
342700400
ADMINISTRATOR:
ROODENBURG, FRANS
FACILITY TYPE:
740
ADDRESS:
3105 HEMPSTEAD RD
TELEPHONE:
(916) 485-7420
CITY:
SACRAMENTO
STATE:
CA
ZIP CODE:
95864
CAPACITY:
6
CENSUS:
5
DATE:
02/15/2024
TYPE OF VISIT:
POC
UNANNOUNCED
TIME BEGAN:
10:45 AM
MET WITH:
Milagros Dioso
TIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to follow up on a plan of correction developed on 1/29/24. LPA Moleski met with licensee Milagros Dioso and explained the purpose of the visit.
LPA Moleski cited this facility on 1/29/24 per 22 CCR Section
87303(e)(2) due to water temperatures below 105 degrees. LPA Moleski re-tested the water during this visit and observed that temperatures were too hot. The facility's water heater was adjusted during this visit. LPA Moleski will return to re-test until a range between 105 and 120 can be reached.
No deficiencies were cited during this visit. An exit interview was held and a copy of this report was left with Dioso.
SUPERVISORS NAME
:
Stephen Richardson
LICENSING EVALUATOR NAME
:
Vincent Moleski
LICENSING EVALUATOR SIGNATURE
:
DATE:
02/15/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/15/2024
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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