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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002798
Report Date: 06/20/2024
Date Signed: 06/20/2024 11:08:33 AM


Document Has Been Signed on 06/20/2024 11:08 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:OAKMONT OF ROSEVILLEFACILITY NUMBER:
315002798
ADMINISTRATOR:PARVANEH MANOUCHEHRIFACILITY TYPE:
740
ADDRESS:1101 SECRET RAVINE PARKWAYTELEPHONE:
(916) 771-6700
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY:120CENSUS: 83DATE:
06/20/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:PARVANEH MANOUCHEHRITIME COMPLETED:
09:30 AM
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On 6/20/2024, Licensing Program Analyst (LPA) Cassie Yang arrived to the facility unannounced to conduct a required annual inspection. LPA met with Executive Director and explained the purpose of the visit.

Today's visit, LPA is conducting an annual inspection today but this report is being generated to clear the Post-Licensing inspection in the system.

There are no citations issued on this report.

Exit interview. Copy of report provided.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: (916) 201-1928
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2024
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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