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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312701032
Report Date: 07/24/2024
Date Signed: 07/24/2024 03:53:28 PM

Document Has Been Signed on 07/24/2024 03:53 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:AMI HOUSING, INC.FACILITY NUMBER:
312701032
ADMINISTRATOR/
DIRECTOR:
JENNIFER PRICEFACILITY TYPE:
735
ADDRESS:1720 LILAC LANETELEPHONE:
(530) 878-5088
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY: 15CENSUS: 10DATE:
07/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Brooke Hegel, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 7/24/2024 LPA Tryon visited the facility to conduct an annual visit. LPA met with Administrator in Training Brooke Hegel.
The facility currently has 10 residents.
LPA toured the facility including common areas, kitchen, bedrooms, bathrooms, hallways, yard, storage. The house is separated into two separate "wings" with bedrooms on each end.
Food supplies are appropriate to meet the requirement of 2 days perishable and 7 days non-perishable. Sharp knives are locked in a kitchen cupboard. Cleaners are stored in a secured locker. The home has plenty of dishes, flatware, pots, pans, storage dishes, etc. Medications are centrally stored and locked in the staff office. There are activities such as TV, videos, games and so forth available.
The house was clean, nicely furnished and decorated.
There were 4 staff present when LPA arrived; and LPA also met program director and current administrator/COO during the visit.

LPA reviewed the CARE Tool.
LPA reviewed 4 resident files and 4 staff files.
LPA interviewed 3 residents during the visit. All residents expressed that they like living at the facility and their needs are met by the staff.

No deficiencies were cited at this visit. Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024
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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