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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920023
Report Date: 12/19/2023
Date Signed: 12/19/2023 02:52:12 PM


Document Has Been Signed on 12/19/2023 02:52 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:DAD'S PLACE, INC.FACILITY NUMBER:
315920023
ADMINISTRATOR:MURRAY, KATHERINE S.FACILITY TYPE:
740
ADDRESS:8100 HORSESHOE BAR RD.TELEPHONE:
(530) 718-0932
CITY:LOOMISSTATE: CAZIP CODE:
95650
CAPACITY:6CENSUS: 6DATE:
12/19/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Tyler ChesterTIME COMPLETED:
03:00 PM
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On Tuesday December 19, 2023, Licensing Program Analyst Melissa Parks arrived to conduct an unannounced post licensing inspection.

LPA reviewed 2 resident and 1 staff files. All resident files contained the required paperwork. All staff files contained the required paperwork and training.

LPA toured the facility with Operations Manager Tyler. The following areas were inspected: resident rooms, resident bathrooms, and kitchen.

No deficiencies cited. An exit interview conducted. A copy of this report was emailed.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2023
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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