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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004061
Report Date: 09/11/2024
Date Signed: 09/11/2024 11:12:53 AM

Document Has Been Signed on 09/11/2024 11:12 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:WILLOW CREEK MANORFACILITY NUMBER:
347004061
ADMINISTRATOR/
DIRECTOR:		LEPADAT, GABRIELAFACILITY TYPE:
740
ADDRESS:216 WILLOW CREEK DRTELEPHONE:
(916) 984-6918
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY: 6CENSUS: 4DATE:
09/11/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Pamela Flemming, CaregiverTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct a POC visit. LPA spoke to administrator Gabriela Lepadat over the phone and met with caregiver Pamela Flemming during today's inspection.

LPA toured the facility and inspected resident rooms and common areas. LPA observed all deficiencies cited on 8/08/24 have been cleared. POC letter and a copy of report was provided.

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2024
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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