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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
347005239
Report Date:
02/28/2025
Date Signed:
02/28/2025 11:53:59 AM
Document Has Been Signed on
02/28/2025 11:53 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 SOUTH ASC
,
9835 GOETHE ROAD, SUITE 100
SACRAMENTO
,
CA
95827
FACILITY NAME:
GREENHAVEN ESTATES
FACILITY NUMBER:
347005239
ADMINISTRATOR/
DIRECTOR:
LATRICE ROSS
FACILITY TYPE:
740
ADDRESS:
7548 GREENHAVEN DR
TELEPHONE:
(916) 427-8887
CITY:
SACRAMENTO
STATE:
CA
ZIP CODE:
95831
CAPACITY:
105
CENSUS:
47
DATE:
02/28/2025
TYPE OF VISIT:
POC
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:
Latrice Ross
TIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On 2/28/25 Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced POC inspection to ensure previously cited deficiencies have been corrected as agreed upon by the department and facility representatives.
LPA reviewed outstanding POCs and observed all corrections to have been made and all items identified are currently in compliance with title 22 regulations. POC letters generated and left at the facility.
no deficiencies were observed or cited during today's inspection.
Exit interview conducted and a copy of this report was left at the facility.
SUPERVISORS NAME
:
Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME
:
Kevin Gould
LICENSING EVALUATOR SIGNATURE
:
DATE:
02/28/2025
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/28/2025
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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