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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345003014
Report Date: 06/11/2024
Date Signed: 06/11/2024 02:55:38 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/11/2024 02:55 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:LITTLE BROOK CARE HOME #3FACILITY NUMBER:
345003014
ADMINISTRATOR:POP, PERSIDAFACILITY TYPE:
740
ADDRESS:7300 NOB HILL DRTELEPHONE:
(916) 500-4512
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 6DATE:
06/11/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Persida PopTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Melissa Parks arrived on Tuesday June 11, 2024 to conduct an annual continuation inspection.

LPA Parks and Administrator Persida toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, living room, kitchen, and backyard. In the areas toured, there were no health or safety violations observed.

Facility was clean and well organized. Fire Extinguisher has current inspection tag. First aid kit is fully stocked. All required posting were observed.

No deficiencies cited. Exit interview conducted. A copy of this report was emailed to the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:
DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/11/2024
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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