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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622265
Report Date: 03/24/2023
Date Signed: 03/24/2023 02:23:00 PM


Document Has Been Signed on 03/24/2023 02:23 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:CARBAJAL ATTAOUS, SARAFACILITY NUMBER:
343622265
ADMINISTRATOR:CARBAJAL ATTAOUS, SARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 390-9791
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:14CENSUS: 2DATE:
03/24/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Sara Carbajal AttaousTIME COMPLETED:
02:30 PM
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Licensing Program Analysts Erwina Pascual-Golamco and Jennifer Velasco (LPAs) conducted a case management visit for the purpose of completing documentation of a prior visit to the facility, at which a signature was not retained on a document.

There were no deficiencies cited during this visit. A notice of site visit was provided to Licensee (L1), who posted it where visible to parents for 30 days.
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2023
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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