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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
342701107
Report Date:
11/05/2022
Date Signed:
11/14/2022 02:33:09 PM
Document Has Been Signed on
11/14/2022 02:33 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
,
2525 NATOMAS PARK DR. STE.270
SACRAMENTO
,
CA
95833
FACILITY NAME:
REGENCY PLACE
FACILITY NUMBER:
342701107
ADMINISTRATOR:
CRUZ, ELIZABETH
FACILITY TYPE:
740
ADDRESS:
8190 ARROYO VISTA DRIVE
TELEPHONE:
(916) 681-7800
CITY:
SACRAMENTO
STATE:
CA
ZIP CODE:
95823
CAPACITY:
61
CENSUS:
DATE:
11/05/2022
TYPE OF VISIT:
Post Licensing
UNANNOUNCED
TIME BEGAN:
02:29 PM
MET WITH:
Cruzx
TIME COMPLETED:
02:30 PM
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Annual report was completed on 11/5/2022
SUPERVISOR'S NAME:
Stephenie Doub
TELEPHONE:
(916) 263-2131
LICENSING EVALUATOR NAME:
Albert Johnson
TELEPHONE:
(916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE:
11/14/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/14/2022
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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