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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005413
Report Date: 11/07/2023
Date Signed: 11/07/2023 02:07:28 PM


Document Has Been Signed on 11/07/2023 02:07 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:ASPEN MEADOWSFACILITY NUMBER:
317005413
ADMINISTRATOR:GRACE HAWKINSFACILITY TYPE:
740
ADDRESS:531 ASPEN MEADOWS WAYTELEPHONE:
(916) 409-5620
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY:6CENSUS: 3DATE:
11/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Daniel GalangTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Melissa Parks arrived on Tuesday November 7, 2023 to conduct the unannounced annual inspection.

LPA met with staff Daniel and explained the purpose of the visit.

LPA reviewed 3 resident and 3 staff files. All resident files contained the required paperwork. All staff files contained the required paperwork.

Due to the current Administrators time conflicts, this annual will be completed at a future date.

No deficiencies cited. Exit interview conducted. A copy of this report was emailed to the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2023
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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