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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
342790074
Report Date:
08/15/2024
Date Signed:
08/15/2024 11:03:25 AM
Document Has Been Signed on
08/15/2024 11:03 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
SACRAMENTO SOUTH ASC
,
9835 GOETHE ROAD, SUITE 100
SACRAMENTO
,
CA
95827
FACILITY NAME:
COMPREHENSIVE SKILLS TRAINING CENTER, LLC.
FACILITY NUMBER:
342790074
ADMINISTRATOR/
DIRECTOR:
SAMSON, JASMIN P
FACILITY TYPE:
775
ADDRESS:
6520 44TH STREET, STE. 306
TELEPHONE:
(916) 391-9100
CITY:
SACRAMENTO
STATE:
CA
ZIP CODE:
95823
CAPACITY:
50
CENSUS:
30
DATE:
08/15/2024
TYPE OF VISIT:
Collateral
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:
Gary Palma
TIME VISIT/
INSPECTION COMPLETED:
11:15 AM
NARRATIVE
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct a collateral visit. LPA Moleski met with program coordinator Gary Palma and explained the purpose of the visit.
LPA Moleski reviewed a client's (C1's) records and interviewed staff.
No deficiencies were cited during this visit. An exit interview was held and a copy of this report was left with Palma.
SUPERVISORS NAME
:
Stephen Richardson
LICENSING EVALUATOR NAME
:
Vincent Moleski
LICENSING EVALUATOR SIGNATURE
:
DATE:
08/15/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/15/2024
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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