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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005428
Report Date: 08/03/2023
Date Signed: 08/03/2023 03:47:11 PM


Document Has Been Signed on 08/03/2023 03:47 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



FACILITY NAME:ATRIA ROCKLINFACILITY NUMBER:
317005428
ADMINISTRATOR:DANA STANSELFACILITY TYPE:
740
ADDRESS:3201 SANTA FE WAYTELEPHONE:
(916) 435-8800
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY:105CENSUS: 84DATE:
08/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Dana Stansel, AdministratorTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct an annual inspection. LPA met with Administrator Dana Stansel during today's inspection.

During today's inspection LPA reviewed 6 resident files and 6 staff files. A review of staff records indicates that all facility staff has received criminal record clearances and/or are associated to this facility. Resident records contain all required documents. CCL observed a copy of current liability insurance.

Due to time restraints LPA will return on later date to complete annual inspection.

Exit interview conducted and copy of report provided to administrator.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2023
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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