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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004156
Report Date: 04/16/2021
Date Signed: 04/16/2021 12:06:56 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:CARLTON CROWN PLAZAFACILITY NUMBER:
347004156
ADMINISTRATOR:MARYBEL PARKERFACILITY TYPE:
740
ADDRESS:1071 FULTON AVE.TELEPHONE:
(916) 971-4800
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:99CENSUS: 46DATE:
04/16/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Marybel Parker TIME COMPLETED:
11:51 AM
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Licensing Program Analyst Avelina Martinez contacted the facility via telephone to conduct a case management on 04/16/2021 due to COVID-19 and pre-cautionary measures. LPA identified herself and discussed the purpose of the call and the elements of the case management with Marybel Parker.

The purpose of the case management visit is to follow up on a Decision and Order. Marybel Parker reported Maribel Campos Arreola last day in the facility was 04/16/2021.

An exit interview was conducted with Marybel Parker via telephone, and a copy of this report was provided to Marybel Parker via email, and an electronic email read receipt confirms receiving these documents.



SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021
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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