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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700157
Report Date: 01/23/2025
Date Signed: 01/23/2025 02:04:11 PM

Document Has Been Signed on 01/23/2025 02:04 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:CHALET, THEFACILITY NUMBER:
342700157
ADMINISTRATOR/
DIRECTOR:		SUSIE DIZONFACILITY TYPE:
740
ADDRESS:6487 MAIN STREETTELEPHONE:
(925) 787-2740
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY: 41CENSUS: 26DATE:
01/23/2025
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Assistant Administrator,Suzanne Dizon TIME VISIT/
INSPECTION COMPLETED:
02:20 PM
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On 01/23/25, Licensing Program Analyst (LPA) Talwinder Bains conduced a Case Management visit to conduct health and safety check at facility. LPA met with Assistant Administrator, Suzanne Dizon and explained the purpose of this visit.

During the health and safety check, LPA toured the facility briefly and conducted staff interviews.
Based on the tour of this facility, the facility appeared to be in good repair.



Exit interview conducted and a copy of the report was provided .
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
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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