<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005712
Report Date: 09/18/2023
Date Signed: 09/18/2023 02:16:13 PM

Document Has Been Signed on 09/18/2023 02:16 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:LOCAL AMBASSADORS INCFACILITY NUMBER:
347005712
ADMINISTRATOR:HOLLAR, ANEETAFACILITY TYPE:
775
ADDRESS:870 GLENN DRIVE, STE 100TELEPHONE:
(916) 606-6770
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY: 30CENSUS: 14DATE:
09/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Administrator Aneeta HollarTIME COMPLETED:
02:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Lavinia Muscan arrived on 9/18/23 to conduct the annual inspection.

During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed client (5) and staff files (5). Client file contained the required paperwork. Staff file contained the required paperwork. Staff has current first aid and CPR training. Facility was clean and well organized. Facility is current on fire drills. All required posting were observed. Staff training contained the required initial training.

LPA toured the interior and exterior of the facility together with Administrator Aneeta Hollar to ensure health and safety of clients in care. Areas toured include but are not limited to: common areas and two (2) bathrooms. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Administrator completed the Compliance and Regulatory enforcement Tool and facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of todays inspection.

LPA requested a copy of the LIC 500, LIC610E and current liability insurance to be sent to the Department by end of the month.

Exit interview conducted. A copy of this report was printed and given to Administrator.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE: DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1