342701678-2-23-2026-27-AS-SHUS-DRL7AJ-20260223202938

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342701678
Report Date: 02/23/2026
Date Signed: 02/23/2026 08:30:06 PM

Document Has Been Signed on 02/23/2026 08:30 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:	ESTELA HOME CARE		FACILITY NUMBER:	342701678
ADMINISTRATOR/ DIRECTOR:	RUFAEL, MULU		FACILITY TYPE:	740
ADDRESS:	1 NITEL CT		TELEPHONE:	(408) 329-8282
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95758
CAPACITY: 6		CENSUS: 0	DATE:	02/23/2026
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:09 PM
MET WITH:	Applicant: Mulu Rufael		TIME VISIT/ INSPECTION COMPLETED:	03:30 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 2/23/2026 at 1:00 PM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived announced to conduct a Pre-Licensing Inspection of the facility to ensure compliance with Title 22 regulations. LPA Hughes met with the licensee Mulu, who assisted LPA Hughes in today’s inspection. This Applicant is seeking licensure for a (5) Non-ambulatory and (1) Ambulatory Residential Care Facility for the Elderly (RCFE) to accept and retain at any given time. The facility will have (2) facility staff with no live-in care staff. There were no residents at this time. The facility administrator's certificate # 7027211740 expires on 01/09/2028. The facility has an infection control plan and an emergency disaster plan completed and provided to Licensing for approval. LPA Hughes toured the facility, and inspected the kitchen area cabinets and drawers were opened and reviewed, silverware, plates, and utensils were observed to be sufficient to meet the needs of the residents at this time. Knives, cleaning agents, and bleach were observed to be locked and made inaccessible to the residents. The food storage unit, facility refrigerator, was observed to be functional and in good repair. Food supplies were reviewed for adequate 2-day perishables and 7-day non-perishable quantities, and they both were observed sufficient a this time. The common area and dining area were observed to be furnished and sufficient to meet the needs of the residents at this time. LPA observed activities and board games made available in the facility. LPA Hughes observed a telephone made available to residents in the common area, LPA observed the required posters posted. The facility smoke detectors, carbon detectors and fire extinguisher were observed to be in good condition. The fire extinguisher was last serviced on 10/22/2025. The water temperature measured at 107.6 degrees Fahrenheit, and the facility temperature measured at 68 degrees Fahrenheit. Continuation 809-C

NAME OF LICENSING PROGRAM MANAGER: Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM ANALYST: Shakaricka Hughes
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/23/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ESTELA HOME CARE	FACILITY NUMBER: 342701678
	VISIT DATE: 02/23/2026

NARRATIVE

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Linen closet was observed and a sufficient supply of sheets, bedding, pillowcases, and blankets to were available to meet the needs of the residents. LPA observed a washer and dryer in the facility, in good repair at this time. LPA observed sufficient hygiene items on the premises. Residents’ bedrooms were toured, furniture and furnishings were observed to be sufficient and able to meet the needs of the residents. LPA observed the centrally stored medication areas to be locked. LPA observed a storage cabinet located inside of the staff room for personnel and resident records. LPA inspected the first aid kit and it was complete.

LPA toured the garage and courtyard. LPA observed the outdoor area equipped for outdoor use, free of obstruction and enclosed by a fence with a self latching side gate. LPA observed a outdoor shed, clean and empty at this time. The emergency exits were observed unobstructed.

A Component III was completed at this time with the Applicant. The applicant has passed the pre-licensing component of the application process. LPA Hughes will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed. An exit interview was conducted, and a copy of this report was provided to the Applicant.

NAME OF LICENSING PROGRAM MANAGER: Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM ANALYST: Shakaricka Hughes
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/23/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2026

LIC809 (FAS) - (06/04)

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