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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001696
Report Date: 03/14/2024
Date Signed: 03/14/2024 02:14:13 PM

Document Has Been Signed on 03/14/2024 02:14 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:LA HONDA GUEST HOMEFACILITY NUMBER:
347001696
ADMINISTRATOR:TORRES, MARGARITAFACILITY TYPE:
740
ADDRESS:3940 LA HONDA WAYTELEPHONE:
(916) 944-8909
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 6CENSUS: 4DATE:
03/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Neal TorresTIME COMPLETED:
02:00 PM
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On 3/14/2024, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a Required 1-year annual inspection utilizing the full CARE tool. LPA met with Licensee, Neal Torres, and explained the purpose of the visit.

During today's visit, LPA observed the posted license to be outdated as it does not state facility is licensed for five non-ambulatory and one bedridden. LPA informed Licensee LPA will provide an updated license at earliest convenience.

At time of LPA's visit, LPA observed there was a medical emergency for R1. LPA informed Licensee the annual inspection will be continued another day.

No deficiencies cited.

Exit interview conducted.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2024
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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