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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002972
Report Date: 03/08/2024
Date Signed: 03/11/2024 11:51:32 AM

Document Has Been Signed on 03/11/2024 11:51 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:GOOD SAMARITAN CARE FACILITYFACILITY NUMBER:
345002972
ADMINISTRATOR:DANIELYAN, DANIELFACILITY TYPE:
740
ADDRESS:4406 BARRETT ROADTELEPHONE:
(916) 458-2615
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 6CENSUS: 4DATE:
03/08/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
09:58 AM
MET WITH:Daniel DanielyanTIME COMPLETED:
11:00 AM
NARRATIVE
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On 03/08/2024 at 10:00AM, an informal conference was conducted virtual via Microsoft Teams Meeting. The purpose of this informal conference meeting is to discuss the deficiencies observed during annual inspection conducted on 02/09/2024. Present in the meeting is, Licensing Program Manager (LPM) Anthony Perez, Licensing Program Analyst (LPA) Cassie Yang, and licensee/administrator, Daniel Danielyan.

The informal conference process was explained during this meeting.

Issues discussed during the meeting were:
- Staff training
- Fingerprint clearance
- Facility Records

The facility has stated they will do the following to achieve continued and substantial compliance:
• Submit a letter of understanding of Title 22 by Friday March 15, 2024.
• Reach out to Community Care Licensing Division (CCLD) as a resource.

Technical Support Program was offered and accepted.

No deficiencies cited. LPA will clear the following citations from 02/09/2024 and a Proof of Correction Letter will be mailed to the facility.

Exit interview conducted. Informal meeting concluded and a copy of report will be emailed. Facility Representative Signature is expected to be signed and returned to LPA by close of business, 03/08/2024.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2024
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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