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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920073
Report Date: 11/07/2024
Date Signed: 11/07/2024 11:25:18 AM

Document Has Been Signed on 11/07/2024 11:25 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:WHOLESOME ELDERLY ON MAR VISTAFACILITY NUMBER:
345920073
ADMINISTRATOR/
DIRECTOR:		RAMIREZ, JUANFACILITY TYPE:
740
ADDRESS:7401 MAR VISTA WAYTELEPHONE:
(916) 678-0268
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY: 6CENSUS: 5DATE:
11/07/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Administrator- Juan Ramirez TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 11/07/24, Licensing Program Analysts (LPAs) Cheyenne Ratajczak and Graham Gunby arrived at the facility unannounced to conduct a case management visit. LPAs met with Administrator, Juan Ramirez and explained the purpose of the visit.

The facility is currently licensed for six (6) non-ambulatory, hospice waiver of six (6). During today's visit, there are five (5) residents and zero (0) resident on hospice services.

During today's visit, LPA and Administrator discussed the live in staff policies, and other topics regarding residents and the facility. LPA and Administrator toured the facility to ensure the health and safety of residents in care. In areas toured, no immediate health and safety violation observed. LPA conducted interviews with residents and staff that were present at the facility.

As a result of today's inspection, no deficiencies cited at this time.

Exit interview conducted and a copy of the report was left at the facility.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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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