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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 310300209
Report Date: 01/25/2024
Date Signed: 01/25/2024 03:04:15 PM

Document Has Been Signed on 01/25/2024 03:04 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:ERICKSON'S FAMILY CARE HOMEFACILITY NUMBER:
310300209
ADMINISTRATOR:MAXWELL, LINDAFACILITY TYPE:
735
ADDRESS:356 WEST WISE ROADTELEPHONE:
(916) 955-5198
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY: 6CENSUS: 3DATE:
01/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Linda MaxwellTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Melissa Parks arrived on Thursday January 25, 2024 to conduct the unannounced annual inspection.

During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed client (3) and staff (2) files. All resident and staff files contained the required paperwork.

LPA Parks and Licensee Linda toured the facility together to ensure the health and safety of clients in care. The areas toured included bedrooms, kitchen, bathroom, and common areas. Facility is clean and well organized. Facility is current on fire drills. Facility has a full supply of PPE and covid tests. In the areas toured, there were no health or safety violations observed.

No deficiencies cited. Exit interview conducted. A copy of this report was emailed to the Licensee.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2024
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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