<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345003020
Report Date: 05/09/2024
Date Signed: 05/09/2024 04:24:32 PM

Document Has Been Signed on 05/09/2024 04:24 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:CARMICHAEL ESTATES NO. 1FACILITY NUMBER:
345003020
ADMINISTRATOR/
DIRECTOR:		MCFADDEN, REBECCAFACILITY TYPE:
740
ADDRESS:5228 EL CAMINO AVETELEPHONE:
(406) 533-8372
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 6CENSUS: 3DATE:
05/09/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:15 PM
MET WITH:David DelucaTIME VISIT/
INSPECTION COMPLETED:
05:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 5/9/2024, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct an annual continuation visit from the annual inspection conducted on 4/9/2024. LPA met with Administrator and explained the purpose of the visit.

During today's visit, LPA and Licensee conducted a tour of the interior and exterior of the facility to ensure the health and safety of residents in care. In areas toured, no immediate health and safety rights violation was observed.

LPA conducted a file review of residents and personnel files with facility staff. LPA observed the required documents present.

LPA completed the care tool and no deficiencies cited today.

At this time, LPA is requesting facility Liability insurance to be emailed to LPA by Monday May 13, 2024.

Exit interview and a copy of the report was provided.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1