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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803815
Report Date: 07/31/2024
Date Signed: 07/31/2024 03:29:45 PM


Document Has Been Signed on 07/31/2024 03:29 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:AMERICAN ASSISTED LIVINGFACILITY NUMBER:
486803815
ADMINISTRATOR:SUKHJIT SANDHUFACILITY TYPE:
740
ADDRESS:405 KINGS WAYTELEPHONE:
(510) 604-3825
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY:30CENSUS: 25DATE:
07/31/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Mantu Sanhu, AdministratorTIME COMPLETED:
03:30 PM
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On 7/31/2024, Licensing Program Analyst (LPA) Tobola, Licensing Program Manager, Victoria Bertozzi and Regional Manager, Carla Nuti-Martinez held an announced office meeting and met with Administrator, Mantu Sandhu. The purpose of the formal office meeting is to discuss issuance of an Enhanced Civil Penalty, deliver remaining complaint investigation findings and extend the Non-compliance plan for an additional 2-years ending at 8/13/2026 with Administrator agreeing to the Technical Support Program. The Administrator agrees to ensure all incidents are reviewed and reported to Community Care Licensing. In addition, Administrator agrees to ensure all resident files are reviewed, current and on file.

Additional information and resource guide provided at: https://www.cdss.ca.gov/inforesources/community-care/resource-guide-for-providers

No deficiency cited.

SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Dominic TobolaTELEPHONE: (707) 588-5081
LICENSING EVALUATOR SIGNATURE:
DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2024
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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