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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317000780
Report Date: 02/28/2024
Date Signed: 02/28/2024 11:49:55 AM


Document Has Been Signed on 02/28/2024 11:49 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:GLADDING RIDGEFACILITY NUMBER:
317000780
ADMINISTRATOR:KRISTINE REYMONTFACILITY TYPE:
740
ADDRESS:1660 THIRD STREETTELEPHONE:
(916) 645-0106
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY:99CENSUS: DATE:
02/28/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Patrick Doppelmayr, Interim Executive DirectorTIME COMPLETED:
12:05 PM
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Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with Interim Executive Director, Patrick Doppelmayr, to conduct an inspection for the closure of the facility.

LPA observed interior/exterior of the facility, including outdoor area, common areas, dining room, kitchen, bedrooms, and bathrooms. LPA observed that there were no residents at the facility.

LPA received the original License and the facility will be closed in the system as of 2/28/24.

Exit interview conducted. Copy of the report provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Angela HoodTELEPHONE: 650-676-0390
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2024
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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