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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701524
Report Date: 12/02/2024
Date Signed: 12/02/2024 11:13:19 AM

Document Has Been Signed on 12/02/2024 11:13 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:CYCHELLE'S CARE HOME LLCFACILITY NUMBER:
342701524
ADMINISTRATOR/
DIRECTOR:		ALAIZA, GRECHELLEFACILITY TYPE:
740
ADDRESS:3017 SUBARU CT.TELEPHONE:
(916) 271-8406
CITY:SACRAMENTOSTATE: CAZIP CODE:
95826
CAPACITY: 6CENSUS: 4DATE:
12/02/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Grechelle AlaizaTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct a case management visit. LPA Moleski met with facility administrator Grechelle Alaiza and explained the purpose of the visit.

LPA Moleski conducted Component III orientation with Alaiza.

LPA Moleski toured the facility with Alaiza and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas. All areas of the facility appeared clean and in good repair.

No deficiencies were observed during this visit. An exit interview was conducted and a copy of this report was left with Alaiza.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2024
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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