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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005358
Report Date: 10/31/2023
Date Signed: 10/31/2023 02:49:40 PM

Document Has Been Signed on 10/31/2023 02:49 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:AMERICAN RIVER RESIDENTIAL SERVICESFACILITY NUMBER:
347005358
ADMINISTRATOR:SHAWNA VALVERDEFACILITY TYPE:
735
ADDRESS:4741 ENGLE ROADTELEPHONE:
(916) 483-8424
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 28CENSUS: 27DATE:
10/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Emra Madderra and Shawna ValverdeTIME COMPLETED:
03:15 PM
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On 10/31/2023, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a required 1-year annual inspection utilizing the care tool. LPA met with Administrator Shawna Valverde and Service Coordinator Emra Madderra, and explained the purpose of the visit.

LPA and Service Coordinator conducted a tour of the interior of the facility. Areas included but not limited to: common areas, staff office, dining room, linen room, laundry room, Serenity Room, TV room, two spa rooms and four (4) clients room. In areas toured, no health, safety and personal rights was observed.

LPA and Administrator discussed the Administrator Certificate renewals. LPA informed Administrator LPA will reach out to Admin Cert Unit for additional information regarding late renewals. LPA observed Administrator Certificate for Maritza Vindell to be current.

File review was conducted with and found four out of five clients admission agreement to be missing. LPA was informed facility has converted to electronic files and the documents may be located in the miscellaneous electronic file.

LPA completed the care tool and found the facility to be in substantial compliance at this time. No deficiencies cited.

Exit interview conducted and a copy of the report was provided.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2023
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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