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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700583
Report Date: 03/02/2022
Date Signed: 03/03/2022 08:28:49 AM


Document Has Been Signed on 03/03/2022 08:28 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:CHATEAU ON CAPITOL AVENUE, THEFACILITY NUMBER:
342700583
ADMINISTRATOR:TYLER BARNESFACILITY TYPE:
740
ADDRESS:2701 CAPITOL AVENUETELEPHONE:
(916) 447-4444
CITY:SACRAMENTOSTATE: CAZIP CODE:
95816
CAPACITY:81CENSUS: 40DATE:
03/02/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Tyler Barnes TIME COMPLETED:
11:30 AM
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On March 2, 2022 an office visit was conducted virtually, via Microsoft Teams. Present in the meeting were Regional Manager Krystall Moore and Licensing Program Analyst Avelina Martinez. Facility representatives include: Tyler Barnes, Wick Peterson, Dan Williams, Joel Goldman, and Scott Bissey The Department explained the purpose of the visit on March 2, 2022.

The purpose of this virtual Microsoft Teams meeting is to discuss the change of management from SRG to Align. At this meeting, it was learned the submitted abbreviated application has not been approved by Centralized Application Bureau. As of now, SRG will remain providing oversight of this facility.

An exit interview was conducted, and a copy of this report was provided to Tyler Barnes. Moreover, an electronic email read receipt confirms receiving these documents.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2022
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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