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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
345002928
Report Date:
10/12/2023
Date Signed:
10/12/2023 03:25:19 PM
Document Has Been Signed on
10/12/2023 03:25 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 2
FACILITY NUMBER:
345002928
ADMINISTRATOR:
VINSON, DEONTEE
FACILITY TYPE:
735
ADDRESS:
4424 PENWITH 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:
02:20 PM
MET WITH:
NaTasha Harden and Deontee Vinson
TIME COMPLETED:
03:35 PM
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LPA Hiratsuka conducted this unannounced annual visit.
This has a fire clearance for four non-ambulatory and two ambulatory residents. There are two staff rooms and four resident rooms. There are two full common bathrooms and one resident room has a full private bathroom. The common areas are clean and well maintained. The backyard has shed for storage and a gate on both sides that lead to the front.
Staff and client 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.
SUPERVISOR'S NAME:
Troy Ordonez
TELEPHONE:
(916) 263-4700
LICENSING EVALUATOR NAME:
Kerry Hiratsuka
TELEPHONE:
(916) 591-0210
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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