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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002993
Report Date: 01/02/2025
Date Signed: 01/02/2025 02:37:48 PM

Document Has Been Signed on 01/02/2025 02:37 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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MAHALOHA CARE LLCFACILITY NUMBER:
345002993
ADMINISTRATOR/
DIRECTOR:		RIVERA, GERALD JOHN G.FACILITY TYPE:
740
ADDRESS:8223 TWIN OAKS AVETELEPHONE:
(916) 910-9652
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 5DATE:
01/02/2025
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:25 PM
MET WITH:Sashana Barnett, caregiverTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection. LPA met with Sashana Barnett, caregiver, and explained purpose of inspection. The care staff contacted the Administrator, Gerald Rivera, who arrived at 1:45 pm.

LPA and the caregiver conducted a tour of the interior of the facility. LPA observed (4) residents currently resting in either their room or the common area. LPA was advised there is (1) resident who was out of the facility at the start of the inspection. That resident later returned by the end of the inspection.

LPA asked the Administrator if he has any related facilities that are licensed with the Department or if he works at any other facilities. The Administrator indicated he does not have any other licensed facilities but
works part-time at another licensed care home in the area and provided details to an incident occurring on 12/31/24.

There are no deficiencies issued in this report.

Exit interview. Copy of report provided to the Administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/02/2025
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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