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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700098
Report Date: 12/10/2024
Date Signed: 12/10/2024 11:46:55 AM

Document Has Been Signed on 12/10/2024 11:46 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:CARMICHAEL SENIOR CAREFACILITY NUMBER:
342700098
ADMINISTRATOR/
DIRECTOR:		DIZON, MARIA SUSIE VFACILITY TYPE:
740
ADDRESS:5208 FAIR OAKS BLVDTELEPHONE:
(916) 973-9533
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 6CENSUS: 0DATE:
12/10/2024
TYPE OF VISIT:Case Management - Annual ContinuationANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:47 AM
MET WITH:Susie Dizon and Susanne DizonTIME VISIT/
INSPECTION COMPLETED:
11:25 AM
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On 12/10/2024, Licensing Program Analyst (LPA) Cassie Yang arrived at the facility to conduct an annual continuation visit. LPA met with Administrator and explained the purpose of the visit.

During this annual inspection, LPA observed there are no residents in care. Additionally, LPA was informed facility is planning of getting renovation permits and will be doing reconstructions. LPA was informed that facility may continue to remain vacant in 2025. LPA informed Administrator that once renovation is completed to notify LPA for a new fire inspection.

A tour was conducted, areas toured included but not limited to four bedrooms, kitchen, laundry room, bathrooms and the common areas. Areas toured no immediate health, safety and personal rights violations were observed.

LPA was provided a new facility phone number as the current number on file has been disconnected.


As a result of today's visit, no deficiencies cited.

Exit interview conducted.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2024
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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