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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920062
Report Date: 10/18/2024
Date Signed: 10/18/2024 03:50:04 PM

Document Has Been Signed on 10/18/2024 03:50 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:BLESSED HOMECARE 3FACILITY NUMBER:
345920062
ADMINISTRATOR/
DIRECTOR:		ARAMBULO, LERIZAFACILITY TYPE:
740
ADDRESS:6350 SAMOA WAYTELEPHONE:
(209) 834-4040
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 6CENSUS: DATE:
10/18/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:25 AM
MET WITH:LERIZA ARAMBULO and BABY QUINTEROTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On 10/18/2024 at 10:30AM, an informal conference was conducted virtual via Microsoft Teams Meeting.

The purpose of this informal conference meeting is to discuss the pending open investigations. Present in the meeting is, Licensing Program Manager (LPM) Anthony Perez, Licensing Program Analyst (LPA) Cassie Yang, and Facility Administrator , Leriza Arambulo, and Licensee, Baby Quintero.

The informal conference process was explained during this meeting.

Topic discussed:
- Criminal Background Clearance violations
- Fire Safety violations

At this time, the Department agreed to monitor facility. Additionally, Facility will provide the Department a copy of LIC 500 Personnel Roster and install a magnetic door opener. Proof of installation is due to LPA Yang by Thursday October 31, 2024.

No deficiencies cited.

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,10 /18/2024.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2024
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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