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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003297
Report Date: 12/11/2024
Date Signed: 12/11/2024 04:04:01 PM

Document Has Been Signed on 12/11/2024 04:04 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 SERENA HOUSEFACILITY NUMBER:
347003297
ADMINISTRATOR/
DIRECTOR:		VILLAROSA, MARIBELFACILITY TYPE:
740
ADDRESS:8970 LA SERENA DRIVETELEPHONE:
(916) 966-0865
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY: 6CENSUS: 4DATE:
12/11/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Aida Briones, LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Licensee, Aida Briones, to follow-up regarding concerns brought up during a separate inspection conducted on 12/11/2024. During visit, LPA conducted an interview with Licensee. LPA will conduct a follow-up visit if deemed necessary.

No deficiencies are being cited as a result of today's visit. Exit interview was conducted with Licensee. Signature on these forms acknowledges receipt of these documents.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
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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