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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002003
Report Date: 04/14/2023
Date Signed: 04/14/2023 10:20:33 AM

Document Has Been Signed on 04/14/2023 10:20 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 NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:BROAD HORIZONFACILITY NUMBER:
455002003
ADMINISTRATOR:KINGSLEY, SHERRIEFACILITY TYPE:
775
ADDRESS:465 LAKE BLVDTELEPHONE:
(530) 243-9500
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY: 30CENSUS: DATE:
04/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Sherrie KingsleyTIME COMPLETED:
10:30 AM
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LPA Hiratsuka conducted this unannounced annual visit. LPA toured with Administrator Sherrie Kingsley.

The main entrance opens to the main common area. There is a second common room to the left along with two offices and a kitchen area. There are two half common bathrooms, a locked storage area, an office, and a client storage area attached to the first common area.

LPA inspected the areas. LPA reviewed staff and client files.

Multiple topics discussed.

No deficiencies cited.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2023
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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