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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005948
Report Date: 09/20/2023
Date Signed: 09/20/2023 12:29:06 PM

Document Has Been Signed on 09/20/2023 12:29 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:ABLEFACILITY NUMBER:
317005948
ADMINISTRATOR:POURARIAN, AMITISFACILITY TYPE:
775
ADDRESS:8200 SIERRA COLLEGE DTELEPHONE:
(916) 276-6777
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY: 30CENSUS: 0DATE:
09/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Licensee: Amitis Pourarian TIME COMPLETED:
12:45 PM
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On 9/20/2023, Licensing Program Analyst (LPA) Sarena Keosavang arrived to the facility Able - 317005948 unannounced to conduct a Required- 1 Year inspection. LPA met with Licensee, Amitis Pourarian, and explained the purpose of the visit. The facility is not in operation at this time as a Day Program. LPA toured the facility.

No deficiencies issued.

Exit interview. Copy of report provided.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Sarena Keosavang
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2023
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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