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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
455001380
Report Date:
06/08/2023
Date Signed:
06/08/2023 01:15:37 PM
Document Has Been Signed on
06/08/2023 01:15 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
,
2525 NATOMAS PARK DR STE 270
SACRAMENTO
,
CA
95833
FACILITY NAME:
BRAVO PROGRAM
FACILITY NUMBER:
455001380
ADMINISTRATOR:
TRANTHAM, TRISH
FACILITY TYPE:
775
ADDRESS:
9560 CROSSROADS DRIVE
TELEPHONE:
(530) 221-5251
CITY:
REDDING
STATE:
CA
ZIP CODE:
96003
CAPACITY:
30
CENSUS:
DATE:
06/08/2023
TYPE OF VISIT:
Collateral
UNANNOUNCED
TIME BEGAN:
12:52 PM
MET WITH:
Daniel (Willy) Williams
TIME COMPLETED:
01:35 PM
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Licensing Program Analyst (LPA) Ivan Avila arrived to interview clients regarding a complaint in a different location. The issues do not involve this facility.
No deficiencies cited.
SUPERVISORS NAME
:
Lauren Crocker
LICENSING EVALUATOR NAME
:
Ivan Avila
LICENSING EVALUATOR SIGNATURE
:
DATE:
06/08/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/08/2023
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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