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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
317005900
Report Date:
05/26/2021
Date Signed:
05/26/2021 04:33:10 PM
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
520 COHASSET RD., STE. 170
CHICO
,
CA
95926
FACILITY NAME:
MEADOW OAKS OF ROSEVILLE
FACILITY NUMBER:
317005900
ADMINISTRATOR:
SAMANTHA MURPHY
FACILITY TYPE:
740
ADDRESS:
930 OAK RIDGE RD
TELEPHONE:
(916) 774-0200
CITY:
ROSEVILLE
STATE:
CA
ZIP CODE:
95661
CAPACITY:
108
CENSUS:
DATE:
05/26/2021
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
04:00 PM
MET WITH:
Debra
TIME COMPLETED:
04:45 PM
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Licensing Program Analysts (LPAs) Hiratsuka and Williams arrived unannounced to conduct a case management. Administrator Debra stated her facility is currently holding out the alleged perpetrator while her facility performs an investigation.
LPAs are awaiting more facts and the case needs further investigation.
SUPERVISOR'S NAME:
Anthony Perez
TELEPHONE:
(323) 485-4915
LICENSING EVALUATOR NAME:
Jacob Williams
TELEPHONE:
(916) 809-5764
LICENSING EVALUATOR SIGNATURE:
DATE:
05/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/26/2021
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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