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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700573
Report Date: 04/24/2024
Date Signed: 04/24/2024 12:52:04 PM

Document Has Been Signed on 04/24/2024 12:52 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:AKUA BEHAVIORAL HEALTH INC IVFACILITY NUMBER:
342700573
ADMINISTRATOR/
DIRECTOR:		BEZDEK, SEANFACILITY TYPE:
772
ADDRESS:10821 & 10827 FAIR OAKS BLVDTELEPHONE:
(916) 903-7028
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY: 14CENSUS: 11DATE:
04/24/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Jacob Moore, Program ManagerTIME VISIT/
INSPECTION COMPLETED:
01:05 PM
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Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Program Manager, Jacob Moore, to follow-up on a plan of correction made to the facility on 2/22/2024 to be completed on 3/8/2024.

During today's visit, LPA took the temperature of the water and found water temperature to be 113.1 degrees F. Facility has successfully regulated water temperatures to be not less than 105 degrees F and not more than 120 degrees F at the time of this visit. LPA cleared deficiency during visit.

LPA provided technical assistance during visit regarding Administrator.

Exit interview was conducted. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2024
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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