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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700805
Report Date: 09/30/2024
Date Signed: 09/30/2024 09:54:20 AM

Document Has Been Signed on 09/30/2024 09:54 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:NORTHERNCARE FACILITYFACILITY NUMBER:
342700805
ADMINISTRATOR/
DIRECTOR:		WOODWARD, ROSE BALUROFACILITY TYPE:
740
ADDRESS:5016 WATERBURY WAYTELEPHONE:
(530) 762-8199
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY: 6CENSUS: 5DATE:
09/30/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Rose Baluro Woodward, AdministratorTIME VISIT/
INSPECTION COMPLETED:
09:00 AM
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An informal conference was conducted at 8:30 AM on September 30, 2024, with Sacramento North Regional Office via Microsoft Teams. The purpose of this informal conference meeting is to address citations issued during inspections conducted on 5/29/2024 and 8/27/2024. The Administrator was told that this Informal conference is a part of the Administrative Action process and that further noncompliance may result in an elevation to a formal noncompliance conference, which could lead to a referral to the Department's legal division for possible revocation of license.

The following Licensing staff were present:
Licensing Program Analysts (LPAs) Michael Hood and Cassie Mikkelson, and Licensing Program Manager (LPM) Anthony Perez

The following facility representatives were present:
Administrator Rose Baluro Woodward

The following topics were covered during today's meeting:
· An overview regarding 7 Type A citations, 2 Type B citations, and 6 civil penalties
· Status of pending plan of corrections

Administrator stated that they have completed pending corrections and LPA will conduct a follow-up visit to clear deficiencies. Facility was notified that the Department may increase monitoring at the facility. Technical support was offered to facility representative during meeting.

An exit interview was conducted and a copy of this report will be provided to the facility via email. A copy must be signed and returned to the Department.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2024
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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