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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005526
Report Date: 10/07/2024
Date Signed: 10/08/2024 10:12:31 AM

Document Has Been Signed on 10/08/2024 10:12 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:REACH ADULT DEVELOPMENT SITE #4FACILITY NUMBER:
317005526
ADMINISTRATOR/
DIRECTOR:		SUH, SEANFACILITY TYPE:
775
ADDRESS:1140 SUNSET BLVD STE 145TELEPHONE:
(916) 616-0729
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY: 30CENSUS: 14DATE:
10/07/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Karissa Blair, Case ManagerTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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On 10/7/2024 LPA Tryon visited the facility to amend a 9099 for complaint # 59-AS-20240611154355. When the LPA was at the facility last to amend/fix the document, the outcome somehow changed to UNFOUNDED, when it should have been UNSUBSTANTIATED.

The change was shared with Case Manager Karissa Blair, and documents were signed.

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2024
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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