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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701362
Report Date: 06/18/2024
Date Signed: 06/18/2024 11:01:14 AM

Document Has Been Signed on 06/18/2024 11:01 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, 744 P STREET, MS 9-14-8201
SACRAMENTO, CA 95814
FACILITY NAME:VALLEY OF HOPE FACILITYFACILITY NUMBER:
342701362
ADMINISTRATOR/
DIRECTOR:		INUKIHAANGANA, SITINA TFACILITY TYPE:
740
ADDRESS:2348 COTTAGE WAYTELEPHONE:
(916) 397-3390
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY: 5CENSUS: 0DATE:
06/18/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Sitina Inukihaangana, Applicant/AdministrartorTIME VISIT/
INSPECTION COMPLETED:
10:51 AM
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Component II completion: Unsuccessful

Facility Type: Residential Care Facility for Elderly (RCFE)
Application Type: Initial
Capacity: 5
Census (if any clients in care): none
COMP II Participants: Sitina Inukihaangana, Applicant/Administrator
Interview Method: Telephone interview

On June 18, 2024 at 10:00 AM, applicant/administrator participated in COMP II. Identification of the applicant/administrator was verified through interview questions based on photo ID and other identifying personal information. During the COMP II, applicant/administrator did not provide sufficient knowledge of the program and/or community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Component II will be rescheduled once applicant/administrator is ready.


Exit interview conducted with applicant/administrator. Report sent via email and request to return sign copy by end of business day. Applicant plans to contact CAB within 2 weeks to reschedule COMPONENT II interview.
SUPERVISORS NAME: Darla Neeley
LICENSING EVALUATOR NAME: Celia Phomphachanh
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2024
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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