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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
317005948
Report Date:
10/10/2024
Date Signed:
10/10/2024 04:43:24 PM
Document Has Been Signed on
10/10/2024 04:43 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:
ABLE
FACILITY NUMBER:
317005948
ADMINISTRATOR/
DIRECTOR:
POURARIAN, AMITIS
FACILITY TYPE:
775
ADDRESS:
8200 SIERRA COLLEGE D
TELEPHONE:
(916) 276-6777
CITY:
ROSEVILLE
STATE:
CA
ZIP CODE:
95661
CAPACITY:
30
CENSUS:
0
DATE:
10/10/2024
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
04:25 PM
MET WITH:
Amitis Pourarian
TIME VISIT/
INSPECTION COMPLETED:
04:50 PM
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LPA Hiratsuka conducted this unannounced annual visit. LPA met with Administrator Amitis Pourarian.
This facility currently does not have clients. LPA toured the facility and did not find any deficiencies.
LPA requested Administrator to notify Community Care Licensing Division when she accepts client.
No deficiencies cited.
SUPERVISORS NAME
:
Troy Ordonez
LICENSING EVALUATOR NAME
:
Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/10/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/10/2024
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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