<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701442
Report Date: 09/12/2024
Date Signed: 09/12/2024 01:50:50 PM

Document Has Been Signed on 09/12/2024 01:50 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:EZ CAREFACILITY NUMBER:
342701442
ADMINISTRATOR/
DIRECTOR:		KAKUTA, MODORIFACILITY TYPE:
740
ADDRESS:6240 FENNWOOD CT.TELEPHONE:
(916) 716-9596
CITY:SACRAMENTOSTATE: CAZIP CODE:
95831
CAPACITY: 6CENSUS: 0DATE:
09/12/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Khaula NixonTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 9/12/24 at 1:30pm Licensing Program Analyst (LPA) Kevin Gould arrived at EZ Care for the purpose of conducting a pre-licensing inspection. LPA met with Applicant Khaula Nixon and current licensee and administrator Modori Katuka and together conducted a tour of the home. There are currently no residents in placement.

LPA confirmed the following corrections have been made: All light fixtures are working and operational. Back bedroom has a bed and all bedrooms and common areas have had personal items removed. LPA observed a new lock on medications storage cabinet.

At the time of inspection, the applicant has met all requirements to be licensed. LPA has no objections to the facility being licensed based on meeting all title 22 pre-licensing requirements.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
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)
Page: 1 of 1