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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700996
Report Date: 05/18/2023
Date Signed: 05/18/2023 03:54:21 PM

Document Has Been Signed on 05/18/2023 03:54 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:WELLQUEST GRANITE BAY TENANTCO LLCFACILITY NUMBER:
312700996
ADMINISTRATOR:PARI MANOUCHEHRIFACILITY TYPE:
740
ADDRESS:9747 SIERRA COLLEGE BLVDTELEPHONE:
(916) 864-9800
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY: 135CENSUS: 110DATE:
05/18/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Pari ManouchehriTIME COMPLETED:
02:30 PM
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LPA Parks arrived on Thursday May 18, 2023 to conduct a case management visit. LPA met with Administrator Pari and explained the purpose of the visit.

This is a health and safety visit regarding S1 and S2. LPA reviewed files and obtained copies of S1 and S2's physicians report, face sheets, care plans, outside agency notes, and emails. LPA interviewed S1 and S2.

No deficiencies cited. Exit interview conducted. A copy of this report was left at the facility.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2023
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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