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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700098
Report Date: 11/21/2024
Date Signed: 11/21/2024 11:48:05 AM

Document Has Been Signed on 11/21/2024 11:48 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:CARMICHAEL SENIOR CAREFACILITY NUMBER:
342700098
ADMINISTRATOR/
DIRECTOR:		DIZON, MARIA SUSIE VFACILITY TYPE:
740
ADDRESS:5208 FAIR OAKS BLVDTELEPHONE:
(916) 973-9533
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) arrived to the facility to conduct a required annual inspection. Upon arrival, LPA observed all curtains to be closed and no answer at the door. LPA attempted contact with the facility phone number on file but the number has been disconnected.

LPA attempted contact with Licensee with email on file, informing Licensee for a call back as LPA will remain at the facility for an additional hour for a staff's arrival.

At 10:15AM, LPA did not receive any response and drafted the following report then vacated the property.
Anthony PerezTELEPHONE: (323) 485-4915
Cassie YangTELEPHONE: (916) 201-1928
DATE: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2024
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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