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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700984
Report Date: 06/21/2022
Date Signed: 06/21/2022 03:16:33 PM


Document Has Been Signed on 06/21/2022 03:16 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:SYCAMORE RESIDENTIAL CARE CENTER, B LLCFACILITY NUMBER:
342700984
ADMINISTRATOR:NASSAR, NADERFACILITY TYPE:
740
ADDRESS:4545 SYCAMORE AVENUE, UNIT BTELEPHONE:
(916) 595-9991
CITY:SACRAMENTOSTATE: CAZIP CODE:
95841
CAPACITY:6CENSUS: 4DATE:
06/21/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Karen Bowers, Residential CoordinatorTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with the Residential Coordinator, Karen Bowers, to conduct an annual required and post licensing visit.

For more information on the post licensing visit please see LIC 809 dated 6/21/2021.

No deficiencies cited for the post licensing visit.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: 916-531-7341
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2022
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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