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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701397
Report Date: 09/12/2024
Date Signed: 09/12/2024 10:30:04 AM

Document Has Been Signed on 09/12/2024 10:30 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:CARING HEART IIFACILITY NUMBER:
342701397
ADMINISTRATOR/
DIRECTOR:		ADUCAYEN, KRISTINEFACILITY TYPE:
740
ADDRESS:7818 WYMARK DRIVETELEPHONE:
(916) 682-4742
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 6CENSUS: 6DATE:
09/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Edward AducayenTIME VISIT/
INSPECTION COMPLETED:
10:40 AM
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Licensing Program Analysts (LPAs) Vincent Moleski and Holly Williams arrived unannounced to conduct a case management visit. LPAs Moleski and Williams spoke with Edward Aducayen over the phone and explained the purpose of the visit. Aducayen said that staff member Remedios Templo could sign this report in his absence.

This facility received an updated fire clearance after an inspection on 7/24/24. LPA Moleski printed and signed an updated license for this facility, reflecting the new fire clearance provisions. LPA Moleski retrieved this facility's old license.

No deficiencies were cited during this visit. An exit interview was held and a copy of this report was left with Templo.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2024
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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