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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343616158
Report Date: 08/31/2023
Date Signed: 08/31/2023 12:10:14 PM


Document Has Been Signed on 08/31/2023 12:10 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:SACRAMENTO ADVENTIST ACADEMYFACILITY NUMBER:
343616158
ADMINISTRATOR:SHARI THOMPSONFACILITY TYPE:
850
ADDRESS:5601 WINDING WAYTELEPHONE:
(916) 481-2300
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:48CENSUS: 22DATE:
08/31/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Shari ThompsonTIME COMPLETED:
12:25 PM
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On August 31, 2023 at approximately 10:35 PM Licensing Program Analyst (LPA) Josiah Gathing met with Director Shari Thompson for the purpose of an unannounced Case Management investigation. The purpose of this inspection was to investigate an incident report submitted to the Licensing program on August 25, 2023. During the investigation LPA conducted interviews, made observations, and collected documentation.

A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and report was reviewed with the Director. This report and appeal rights were printed and provided to the Director. No deficiencies were cited during today's investigation.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Josiah GathingTELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2023
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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