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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
525002810
Report Date:
01/19/2024
Date Signed:
01/19/2024 01:11:04 PM
Document Has Been Signed on
01/19/2024 01:11 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:
TREASURE
FACILITY NUMBER:
525002810
ADMINISTRATOR:
LEAK, TAMRA
FACILITY TYPE:
740
ADDRESS:
25353 LEE ST
TELEPHONE:
(530) 604-2602
CITY:
LOS MOLINOS
STATE:
CA
ZIP CODE:
96055
CAPACITY:
6
CENSUS:
6
DATE:
01/19/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
01:00 PM
MET WITH:
Assistant Administrator- Ana Virgen
TIME COMPLETED:
01:10 PM
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LPA Boyles and Avila arrived at the facility unannounced to deliver an amended annual inspection. Copy of the report was provided to the assistant administrator.
SUPERVISORS NAME
:
Lauren Crocker
LICENSING EVALUATOR NAME
:
Jaynae Boyles
LICENSING EVALUATOR SIGNATURE
:
DATE:
01/19/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/19/2024
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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