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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
345002927
Report Date:
10/12/2023
Date Signed:
10/12/2023 02:11:11 PM
Document Has Been Signed on
10/12/2023 02:11 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:
ASPEN RIDGE COMMUNITIES LLC
FACILITY NUMBER:
345002927
ADMINISTRATOR:
VINSON, DEONTEE
FACILITY TYPE:
735
ADDRESS:
6241 GILMAN WAY
TELEPHONE:
(916) 450-9206
CITY:
NORTH HIGHLANDS
STATE:
CA
ZIP CODE:
95660
CAPACITY:
6
CENSUS:
5
DATE:
10/12/2023
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
12:25 PM
MET WITH:
NaTasha Harden and Deontee Vinson
TIME COMPLETED:
02:15 PM
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LPA Hiratsuka conducted this unannounced annual visit.
This facility has a fire clearance for two ambulatory and four non-ambulatory residents. There are three shared resident rooms and one staff room. One of the bathrooms has its own full private bathroom. There are two sitting areas. There is one full common bathroom There is a shed in the backyard.
-two resident records were reviewed
-three staff files were reviewed
The following shall be updated and submitted to Community Care Licensing by 10/25/2023:
-LIC 500 facility personnel or staff schedule
-LIC 610 emergency disaster plan
-LIC 308 designation of administrative responsibility
no deficiencies cited.
SUPERVISORS NAME
:
Troy Ordonez
LICENSING EVALUATOR NAME
:
Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/12/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/12/2023
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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