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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700524
Report Date: 08/13/2024
Date Signed: 08/13/2024 01:43:03 PM

Document Has Been Signed on 08/13/2024 01:43 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:VRETCHEN MARIE CAREFACILITY NUMBER:
342700524
ADMINISTRATOR/
DIRECTOR:		GARCIA, VRETCHEN MARIE JFACILITY TYPE:
740
ADDRESS:7232 CIRCLET WAYTELEPHONE:
(916) 242-8999
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY: 6CENSUS: 0DATE:
08/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Administrator- Edwin Garcia TIME VISIT/
INSPECTION COMPLETED:
01:50 PM
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On 08/13/24 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the care tool. LPA met with Edwin Garcia, Administrator, and explained the purpose of the visit.

The facility currently has no residents. Facility has no current plans of accepting residents. Administrator will notify LPA if that changes.

LPA toured the facility. Areas toured include but are not limited to: 5 bedrooms and 3 bathrooms for residents, common area, dining room, kitchen, and outdoor area. In the areas toured no immediate health, safety, or personal rights violations were observed.

No deficiencies are being cited.

Exit interview conducted and copy of report left at the facility.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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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