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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002811
Report Date: 08/16/2023
Date Signed: 08/16/2023 02:08:40 PM


Document Has Been Signed on 08/16/2023 02:08 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:CARMEL HOUSEFACILITY NUMBER:
045002811
ADMINISTRATOR:STRICK, KATHERINEFACILITY TYPE:
740
ADDRESS:6 CARMEL PLACETELEPHONE:
(530) 343-8007
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY:6CENSUS: 5DATE:
08/16/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Valerie FredTIME COMPLETED:
02:15 PM
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LPA Jaynae Boyles and LPM Lauren Crocker made an unannounced visit to the facility today to clear the deficiency cited at the annual inspection dated 8/9/2023. The deficiency was observed to be cleared and a POC letter was generated and left at the facility.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae BoylesTELEPHONE: (916) 917-3040
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2023
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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