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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
342700777
Report Date:
06/13/2024
Date Signed:
06/13/2024 04:43:30 PM
Document Has Been Signed on
06/13/2024 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:
SIGNATURE LIVING ON WINDING WAY II
FACILITY NUMBER:
342700777
ADMINISTRATOR:
AFABLE, SCOTT
FACILITY TYPE:
740
ADDRESS:
6270 WINDING WAY
TELEPHONE:
(916) 812-0944
CITY:
CARMICHAEL
STATE:
CA
ZIP CODE:
95608
CAPACITY:
6
CENSUS:
6
DATE:
06/13/2024
TYPE OF VISIT:
Post Licensing
UNANNOUNCED
TIME BEGAN:
04:05 PM
MET WITH:
Scott Afable
TIME COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) Cassie Yang and Department of Consumer Affairs Associate Governmental Program Analyst (AGPA) Jordan McLaughlin arrived unannounced to conduct a required annual inspection. LPA met with Administrator and explained the purpose of the visit.
LPA is conducting an annual inspection today but this report is being generated to clear the Post-Licensing inspection in the system.
There are no citations issued on this report.
Exit interview. Copy of report provided.
SUPERVISOR'S NAME:
Anthony Perez
TELEPHONE:
(323) 485-4915
LICENSING EVALUATOR NAME:
Cassie Yang
TELEPHONE:
(916) 201-1928
LICENSING EVALUATOR SIGNATURE:
DATE:
06/13/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/13/2024
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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