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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920062
Report Date: 11/19/2024
Date Signed: 11/20/2024 08:36:55 AM

Document Has Been Signed on 11/20/2024 08:36 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: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: 4DATE:
11/19/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:20 PM
MET WITH:Baby QuinteroTIME VISIT/
INSPECTION COMPLETED:
02:55 PM
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On November 19, 2024, Licensing Program Analyst (LPA) Cassie Yang arrived to the facility to conduct a case management visit. LPA met with Licensee and explained the purpose of the visit.

Today's visit, LPA returned to the facility to provide Licensee all printed documents as visit conducted earlier in the day, there was technical difficulties with printer.

LPA provided Licensee physical copies of two (2) LIC809s, three (3) LIC 421FC's and four (4) Letter of Deficiency Citations Cleared.

At this time, Facility does not have any more plan of corrections (POC) due as pending POC has been received.

Exit interview.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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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