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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
496803583
Report Date:
06/30/2023
Date Signed:
06/30/2023 09:11:07 AM
Document Has Been Signed on
06/30/2023 09:11 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
CCLD Regional Office
,
1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA
,
CA
95405
FACILITY NAME:
ALCHEMIA
FACILITY NUMBER:
496803583
ADMINISTRATOR:
LIZ JAHREN
FACILITY TYPE:
775
ADDRESS:
394 TESCONI COURT
TELEPHONE:
(707) 978-3229
CITY:
SANTA ROSA
STATE:
CA
ZIP CODE:
95401
CAPACITY:
45
CENSUS:
7
DATE:
06/30/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
08:31 AM
MET WITH:
Jessica Martin (Artist Coordinator)
TIME COMPLETED:
09:25 AM
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct interviews regarding complaints unrelated to this facility and met with Jessica Martin, Artist Coordinator.
No deficiencies cited during today's inspection.
SUPERVISORS NAME
:
Bethany Moellers
LICENSING EVALUATOR NAME
:
Marisol Cuadra
LICENSING EVALUATOR SIGNATURE
:
DATE:
06/30/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/30/2023
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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