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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
455002199
Report Date:
01/23/2024
Date Signed:
01/23/2024 09:59:22 AM
Document Has Been Signed on
01/23/2024 09:59 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
,
9835 GOETHE ROAD, SUITE 100
SACRAMENTO
,
CA
95827
FACILITY NAME:
SCS LOREN ROBINSON CENTER
FACILITY NUMBER:
455002199
ADMINISTRATOR:
CRAVENS, JENNIFER
FACILITY TYPE:
775
ADDRESS:
900 B TWIN VIEW BLVD.
TELEPHONE:
(530) 247-8324
CITY:
REDDING
STATE:
CA
ZIP CODE:
96003
CAPACITY:
60
CENSUS:
50
DATE:
01/23/2024
TYPE OF VISIT:
Collateral
UNANNOUNCED
TIME BEGAN:
09:45 AM
MET WITH:
ALICIA ELLER-DILLMAN
TIME COMPLETED:
10:15 AM
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The purpose of this collateral visit is to interview a resident that attends the day program. This is in relation to a complaint at another facility and not a complaint against the day program. Resident was interviewed. An exit interview was conducted and this report was provided to the day program.
SUPERVISORS NAME
:
Lauren Crocker
LICENSING EVALUATOR NAME
:
Donna Gurriere
LICENSING EVALUATOR SIGNATURE
:
DATE:
01/23/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/23/2024
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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