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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345003017
Report Date: 04/09/2024
Date Signed: 04/09/2024 03:42:52 PM


Document Has Been Signed on 04/09/2024 03:42 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:CARMICHAEL ESTATES NO. 3FACILITY NUMBER:
345003017
ADMINISTRATOR:MCFADDEN, REBECCAFACILITY TYPE:
740
ADDRESS:5216 EL CAMINO AVE.TELEPHONE:
(406) 501-5001
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 6DATE:
04/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Rebecca McFadden and Angelica Deluca TIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a 1-year annual inspection utilizing the full CARE tool. LPA met with Administrator, Rebecca McFadden, and explained the purpose of the visit.

LPA and Administrator toured the interior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathrooms, kitchen and dining. In the areas toured no immediate health, safety, or personal rights violations were observed.

The home is clean and odor free. Residents appear to have their care needs met. Food supplies and quality meet requirements.

File review was unable to be completed today. A case management- annual continuation visit will be conducted to complete annual inspection along with file review.

As a result of this inspection, no deficiencies are cited.

Exit interview conducted. Report copy provided.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: (916) 201-1928
LICENSING EVALUATOR SIGNATURE:
DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2024
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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