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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
115002248
Report Date:
04/12/2024
Date Signed:
04/12/2024 09:59:58 AM
Document Has Been Signed on
04/12/2024 09:59 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
,
9835 GOETHE ROAD, SUITE 100
SACRAMENTO
,
CA
95827
FACILITY NAME:
NEIGHBORHOODS AT WESTHAVEN, THE
FACILITY NUMBER:
115002248
ADMINISTRATOR:
ELLIOTT, WADE
FACILITY TYPE:
740
ADDRESS:
1460 FAIRVIEW ST.
TELEPHONE:
(530) 865-5299
CITY:
ORLAND
STATE:
CA
ZIP CODE:
95963
CAPACITY:
32
CENSUS:
20
DATE:
04/12/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
09:30 AM
MET WITH:
Aaron Elliott Director of Operations
TIME COMPLETED:
09:54 AM
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On 4-12-24 Licensing Program Analyst LPA Sarah Benson arrived at the facility unannounced to have Aaron Elliott Director of Operations sign the amended 1 year inspection.
SUPERVISOR'S NAME:
Lauren Crocker
TELEPHONE:
(916) 261-4966
LICENSING EVALUATOR NAME:
Sarah Benson
TELEPHONE:
530-895-5033
LICENSING EVALUATOR SIGNATURE:
DATE:
04/12/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/12/2024
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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