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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002930
Report Date: 04/19/2023
Date Signed: 04/19/2023 03:39:02 PM

Document Has Been Signed on 04/19/2023 03:39 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 NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:MAMA CLAUDIA'S LOVING NESTFACILITY NUMBER:
345002930
ADMINISTRATOR:MIHAI, CLAUDIAFACILITY TYPE:
740
ADDRESS:4230 PARADISE DR.TELEPHONE:
(916) 745-9876
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 6CENSUS: 4DATE:
04/19/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:CaregiverTIME COMPLETED:
03:45 PM
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On 4/19/23, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced visit to follow-up on a call received by LPA on 4/19/23 and met caregiver. Prior to initiating the complaint visit, LPA completed the Department's COVID-19 precautions.

LPA spoke by phone with the licensee regarding the issues associated with a relocation of R1 today. R1 was assisted in R1's move out by R1's responsible party.

LPA interviewed the caregiver regarding recent issues emailed to LPA by R1's responsible party concerning R1's personal belongings and storage space for R1's personal belongings.

LPA observed the home to be clean, safe and sanitary. Current residents appear to have their care needs met by the caregiver present.

As a result of today's visit, no deficiencies are noted.

Report reviewed and copy provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2023
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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