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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001629
Report Date: 08/30/2024
Date Signed: 08/30/2024 12:51:41 PM

Document Has Been Signed on 08/30/2024 12:51 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:MARIA'S HOME CAREFACILITY NUMBER:
347001629
ADMINISTRATOR/
DIRECTOR:		ANDREI COSTEAFACILITY TYPE:
740
ADDRESS:5914 CANARY DRIVETELEPHONE:
(916) 344-5487
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY: 6CENSUS: 5DATE:
08/30/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Staff- Marcia WaiteTIME VISIT/
INSPECTION COMPLETED:
12:55 PM
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On 08/30/24, Licensing Program Analysts (LPAs) Cheyenne Ratajczak and Graham Gunby arrived unannounced at the facility to conduct a collateral visit. LPAs met with staff, Marcia Waite and explained the purpose of the visit.

LPAs conducted a visit to this facility today to follow up on R1 who was relocated to this facility on 08/30/2024. R1 was relocated due to a Temporary Suspension Order issued at another licensed facility by the Department.

LPAs spoke to R1 who indicated that they are adjusting well. R1 has a positive attitude and is optimistic about the change.

No deficiencies are cited during today’s visit.

Exit interview conducted and copy of the report was left at the facility

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2024
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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