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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
502701207
Report Date:
09/24/2024
Date Signed:
09/24/2024 04:38:03 PM
Document Has Been Signed on
09/24/2024 04:38 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 SOUTH ASC
,
9835 GOETHE ROAD, SUITE 100
SACRAMENTO
,
CA
95827
FACILITY NAME:
BELMARE SENIOR LIVING
FACILITY NUMBER:
502701207
ADMINISTRATOR/
DIRECTOR:
CINDY LICHTENHAN
FACILITY TYPE:
740
ADDRESS:
1450 WEST F STREET
TELEPHONE:
(209) 764-3164
CITY:
OAKDALE
STATE:
CA
ZIP CODE:
95361
CAPACITY:
72
CENSUS:
65
DATE:
09/24/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:
Desiree Soria
TIME VISIT/
INSPECTION COMPLETED:
04:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to complete a complaint investigation. During the course of that visit it was learned that Administrator Cindy Lichtenhan is no longer in this position. LPA Jensen met with Business Office Manager Desiree Soria and explained the purpose of the visit.
LPA Jensen was informed that Cindy Lichtenhan's final day of employment was 9/13/24 and that the facility is actively recruiting for a new Administrator.
LPA Jensen provided technical assistance on reporting requirements and requested the following for a change in Administrator:
-A letter from the board appointing the new Administrator
-The applicant's current Administrator's Certificate
-Evidence that the applicant meets the Administrator Qualifications as outlined in CCR 87405
-An updated LIC 500
-An updated LIC 308
-An LIC 501
-An updated LIC 200
LPA Jensen advised the facility has 30 days to appoint a new or an interim Administrator.
An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME
:
Lisa Rios
LICENSING EVALUATOR NAME
:
Maja Jensen
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/24/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/24/2024
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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