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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005413
Report Date: 11/27/2023
Date Signed: 11/27/2023 10:48:17 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/27/2023 10:48 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:ASPEN MEADOWSFACILITY NUMBER:
317005413
ADMINISTRATOR:GRACE HAWKINSFACILITY TYPE:
740
ADDRESS:531 ASPEN MEADOWS WAYTELEPHONE:
(916) 409-5620
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY:6CENSUS: 4DATE:
11/27/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Yas Patawaran, Operations ManagerTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Melissa Parks arrived on Monday November 27, 2023 to conduct a continuation of the unannounced annual inspection.

LPA met with staff Daniel and explained the purpose of the visit. Yas arrived a short time later.

In a previous facility visit, LPA reviewed resident binders and staff files. Today, LPA and Yas toured the facility together to ensure safety of residents in care. The areas toured include resident rooms, bathrooms, garage, kitchen, and backyard. Facility has a fully stocked first aid kit. Medications are kept locked in the kitchen cabinet.

No deficiencies cited. Exit interview conducted. A copy of this report was emailed to Yas.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:
DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/27/2023
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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