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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525002810
Report Date: 04/03/2024
Date Signed: 04/03/2024 12:35:31 PM

Document Has Been Signed on 04/03/2024 12:35 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:TREASUREFACILITY NUMBER:
525002810
ADMINISTRATOR:
ADMINISTRATOR/
DIRECTOR:		LEAK, TAMRAFACILITY TYPE:
740
ADDRESS:25353 LEE STTELEPHONE:
(530) 604-2602
CITY:LOS MOLINOSSTATE: CAZIP CODE:
96055
CAPACITY: 6CENSUS: 6DATE:
04/03/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
TIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Assistant Administrator- Ana Castillo-VirgenTIME COMPLETED:
TIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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LPA Jaynae Boyles and LPM Lauren Crocker made an unannounced visit to the facility today to amend the report dated 9/21/2023 as a result of the facility's appeal to the cited deficiencies on that date. Met with facility staff, Ana Castillo-Virgen . There was 1 deficiency that was overturned with a civil penalty attached that was also dismissed. The report was updated to reflect these changes via the appeal. A copy of the updated report was left at the facility for review.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Jaynae Boyles
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2024
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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