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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003808
Report Date: 08/01/2024
Date Signed: 08/01/2024 10:35:42 AM

Document Has Been Signed on 08/01/2024 10:35 AM - 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:MILIEU CENTER, THEFACILITY NUMBER:
347003808
ADMINISTRATOR/
DIRECTOR:		KINSEY, HEATHERFACILITY TYPE:
775
ADDRESS:3951 PERFORMANCE DRIVETELEPHONE:
(916) 779-2009
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY: 100CENSUS: DATE:
08/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:57 AM
MET WITH:Calvin Hackette, DirectorTIME VISIT/
INSPECTION COMPLETED:
10:58 AM
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On August 1, 2024, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to conduct an annual inspection. LPA met with Calvin Hackett, Director, and informed him the reason for the visit.

LPA and Calvin completed the Infectious Control questionnaire with no concerns or issues.

The current census is 54 .There’s appropriate lighting throughout the facility. LPA inspected the interior of the facility including the common spaces, bathrooms, and multipurpose room, classrooms and kitchen. Bathrooms were clean and in good repair. Fire extinguishers were checked and in good working order. Facility is equipped with pull down smoke alarm system. LPA found the first aid kit to be complete.

LPA reviewed 2 staff files and 2 client files. Both staff and client files were up to date an current with all the pertinent documentation and emergency contact information.

Per California Code of Regulations, Title 22, no citations were issued.

An exit interview was conducted and a copy of this report was given to Calvin.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2024
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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