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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
347003654
Report Date:
04/23/2024
Date Signed:
04/23/2024 02:27:27 PM
Document Has Been Signed on
04/23/2024 02:27 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:
SUTTER HOUSE
FACILITY NUMBER:
347003654
ADMINISTRATOR/
DIRECTOR:
SHERYL C ZONIO
FACILITY TYPE:
735
ADDRESS:
5721 SUTTER AVE
TELEPHONE:
(916) 972-8497
CITY:
CARMICHAEL
STATE:
CA
ZIP CODE:
95608
CAPACITY:
6
CENSUS:
6
DATE:
04/23/2024
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:
Caregiver
TIME VISIT/
INSPECTION COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Angela Hood arrived at the facility unannounced on 4/23/24 and met with the Caregiver to conduct a Required-1 Year Inspection.
LPA had to exit facility due to resident's behaviors.
SUPERVISORS NAME
:
Maribeth Senty
LICENSING EVALUATOR NAME
:
Angela Hood
LICENSING EVALUATOR SIGNATURE
:
DATE:
04/23/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/23/2024
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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