<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002509
Report Date: 05/03/2023
Date Signed: 05/03/2023 11:43:30 AM


Document Has Been Signed on 05/03/2023 11:43 AM - 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



FACILITY NAME:GOLDEN SIERRA CAREHOME INCFACILITY NUMBER:
045002509
ADMINISTRATOR:QUIAMBAO, EDGARDO C.FACILITY TYPE:
740
ADDRESS:2289 BAR TRIANGLE STREETTELEPHONE:
(530) 774-7929
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY:6CENSUS: 5DATE:
05/03/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Maluz RuttmanTIME COMPLETED:
11:50 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LPA Hiratsuka conducted this visit in response to a letter submitted by Licensee yesterday to Community Care Licensing Division. Licensee stated she closed the other facility and relocated the residents to this location. LPA read the letter wrong and thought this location closed.

LPA spoke to Licensee of both facilities via the phone today and cleared the matter up.

No deficiencies cited.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1